January 24, 2024 | Orly Vardeny, Akshay S. Desai, Pardeep S. Jhund, James C. Fang, Brian Claggett, Rudolf A. de Boer, Adrian F. Hernandez, Silvio E. Inzucchi, Mikhail N. Kosiborod, Carolyn S. P. Lam, Felipe A. Martinez, Sanjiv J. Shah, Finnian R. Mc Causland, Mark C. Petrie, Muthiah Vaduganathan, John J. V. McMurray, Scott D. Solomon
This post hoc analysis of the DELIVER trial examined the mode of death and association of dapagliflozin with reduced cause-specific death in patients with heart failure with improved ejection fraction (HFimpEF). The study included 6263 participants, of whom 1151 had HFimpEF. The overall distribution of mode of death was similar between HFimpEF and those with LVEF consistently greater than 40%. Dapagliflozin was associated with lower rates of cardiovascular death compared to placebo in HFimpEF, primarily due to lower rates of sudden death. The findings support current guidelines for using sodium-glucose transport protein 2 inhibitors in HFimpEF and suggest that adding such therapy to guideline-directed medical therapies may reduce cardiovascular mortality. The study highlights that patients with HFimpEF have similar mortality risks as those with LVEF consistently greater than 40%, and dapagliflozin reduces cardiovascular mortality, particularly sudden death. The results indicate that SGLT2i therapy may help reduce cardiovascular mortality in HFimpEF patients. Limitations include small numbers of sudden death events and potential chance associations. The study supports the use of SGLT2i across the spectrum of LVEF and suggests that adding SGLT2i to other guideline-directed therapies may help reduce cardiovascular mortality in HFimpEF.This post hoc analysis of the DELIVER trial examined the mode of death and association of dapagliflozin with reduced cause-specific death in patients with heart failure with improved ejection fraction (HFimpEF). The study included 6263 participants, of whom 1151 had HFimpEF. The overall distribution of mode of death was similar between HFimpEF and those with LVEF consistently greater than 40%. Dapagliflozin was associated with lower rates of cardiovascular death compared to placebo in HFimpEF, primarily due to lower rates of sudden death. The findings support current guidelines for using sodium-glucose transport protein 2 inhibitors in HFimpEF and suggest that adding such therapy to guideline-directed medical therapies may reduce cardiovascular mortality. The study highlights that patients with HFimpEF have similar mortality risks as those with LVEF consistently greater than 40%, and dapagliflozin reduces cardiovascular mortality, particularly sudden death. The results indicate that SGLT2i therapy may help reduce cardiovascular mortality in HFimpEF patients. Limitations include small numbers of sudden death events and potential chance associations. The study supports the use of SGLT2i across the spectrum of LVEF and suggests that adding SGLT2i to other guideline-directed therapies may help reduce cardiovascular mortality in HFimpEF.