Elsevier

JACC: Heart Failure

Volume 10, Issue 2, February 2022, Pages 104-118
JACC: Heart Failure

Mini-Focus Issue: Drug Therapy
Clinical Research
Effect of Dapagliflozin, Compared With Placebo, According to Baseline Risk in DAPA-HF

https://doi.org/10.1016/j.jchf.2021.09.002Get rights and content
Under a Creative Commons license
open access

Abstract

Objectives

The authors sought to examine the effect of dapagliflozin across the spectrum of risk in patients enrolled in DAPA-HF.

Background

In the DAPA-HF (Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure) trial, the sodium-glucose cotransporter 2 inhibitor dapagliflozin decreased the risk of worsening HF events and cardiovascular death in patients with HF and reduced ejection fraction.

Methods

The MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) and the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) PREDICT-HF (Risk of Events and Death in the Contemporary Treatment of Heart Failure) risk models were used to categorize patients according to risk score quintiles. The authors analyzed rates of the primary composite outcome of a worsening HF event or cardiovascular death, its components, and all-cause mortality according to risk quintile and whether risk modified the effect of dapagliflozin.

Results

The MAGGIC score was available for 4,740 of 4,744 patients in DAPA-HF (median score 22 [IQR: 18–25]). A1-point increase was associated with an 8.2% (95% CI: 6.9%–9.4%) higher relative risk of the primary endpoint (P < 0.001). The benefit of dapagliflozin over placebo for the primary endpoint was similar across the spectrum of MAGGIC risk score (interaction P = 0.71). Applying the overall relative risk reduction (26%) with dapagliflozin added to standard therapy resulted in 7 fewer patients in the highest MAGGIC risk quintile experiencing a primary outcome, compared with 2 in the lowest quintile, per 100 person-years of treatment. The findings with PREDICT-HF were similar, although this model led to better risk discrimination.

Conclusions

The benefits of dapagliflozin were consistent across the broad spectrum of baseline risk in DAPA-HF.

Key Words

heart failure
MAGGIC
PREDICT-HF
prognostic model
risk score
sodium-glucose cotransporter 2 inhibitor
survival

Abbreviations and Acronyms

KCCQ
Kansas City Cardiomyopathy Questionnaire
LVEF
left ventricular ejection fraction
NNT
number needed to treat
NYHA
New York Heart Association
SBP
systolic blood pressure

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