January 24, 2024 | Orly Vardeny, PharmD, MS; Akshay S. Desai, MD, MPH; Pardeep S. Jhund, MBChB, MSc, PhD; James C. Fang, MD; Brian Claggett, PhD; Rudolf A. de Boer, MD; Adrian F. Hernandez, MD; Silvio E. Inzucchi, MD; Mikhail N. Kosiborod, MD; Carolyn S. P. Lam, MD; Felipe A. Martinez, MD; Sanjiv J. Shah, MD; Finnian R. Mc Causland, MBChB, MMSc; Mark C. Petrie, MD; Muthiah Vaduganathan, MD, MPH; John J. V. McMurray, MD; Scott D. Solomon, MD
This post hoc analysis of the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial examined the mode of death and the association of dapagliflozin with cause-specific death in patients with heart failure with improved ejection fraction (HFImpEF). HFImpEF is defined as a prior left ventricular ejection fraction (LVEF) of 40% or lower that has increased to greater than 40%. The study included 1515 patients with HFImpEF and 833 patients with LVEF consistently greater than 40%. The overall distribution of mode of death was similar between the two groups, with most deaths being noncardiovascular. However, dapagliflozin was associated with a lower rate of cardiovascular death, primarily due to a significant reduction in sudden deaths. The findings support the use of sodium-glucose transport protein 2 (SGLT2) inhibitors in the treatment of HFImpEF, suggesting that adding an SGLT2 inhibitor to guideline-directed medical therapies may help reduce cardiovascular mortality in these patients.This post hoc analysis of the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial examined the mode of death and the association of dapagliflozin with cause-specific death in patients with heart failure with improved ejection fraction (HFImpEF). HFImpEF is defined as a prior left ventricular ejection fraction (LVEF) of 40% or lower that has increased to greater than 40%. The study included 1515 patients with HFImpEF and 833 patients with LVEF consistently greater than 40%. The overall distribution of mode of death was similar between the two groups, with most deaths being noncardiovascular. However, dapagliflozin was associated with a lower rate of cardiovascular death, primarily due to a significant reduction in sudden deaths. The findings support the use of sodium-glucose transport protein 2 (SGLT2) inhibitors in the treatment of HFImpEF, suggesting that adding an SGLT2 inhibitor to guideline-directed medical therapies may help reduce cardiovascular mortality in these patients.