Atrial Fibrillation and Dapagliflozin Efficacy in Patients With Preserved or Mildly Reduced Ejection Fraction

• DOI: 10.1016/j.jacc.2022.08.718
• Publication Date: 2022-08-27T14:34:58Z
• Authors: Jawad H. Butt; Toru Kondo; Pardeep S. Jhund; Josep Comin-Colet; Rudolf A. de Boer; Akshai S. Desai; Adrian F. Hernandez; Silvio E. Inzucchi; Stefan P. Janssens; Mikhail N. Kosiborod; Carolyn S.P. Lam; Anna Maria Langkilde; Daniel Lindholm; Felipe Martinez; Magnus Petersson; Sanjiv J. Shah; Jorge Thierer; Muthiah Vaduganathan; Subodh Verma; Ulrica Wilderäng; Brian L. Claggett; Scott D. Solomon; John J.V. McMurray
• Keywords: Dapagliflozin; Clinical endpoint

Atrial fibrillation (AF) is common in heart failure (HF), associated with worse outcomes compared sinus rhythm, and may modify the effects of therapy.This study examined dapagliflozin according to presence or not AF DELIVER (Dapagliflozin Evaluation Improve LIVEs Patients With PReserved Ejection Fraction Heart Failure) trial.A total 6,263 patients HF New York Association functional class II-IV, left ventricular ejection fraction >40%, evidence structural disease, elevated N-terminal pro-B-type natriuretic peptide levels were randomized placebo. Clinical effect dapagliflozin, status, examined. The primary outcome was a composite cardiovascular death worsening HF.Of 6,261 data on baseline AF, 43.3% had no 18.0% paroxysmal 38.7% persistent/permanent AF. risk endpoint higher especially driven by rate hospitalization: hospitalization per 100 person-years (4.5 [95% CI: 4.0-5.1]), (7.5 6.4-8.7]), (6.4 5.7-7.1]) (P < 0.001). benefit consistent across types: HR: 0.89 (95% 0.74-1.08); 0.75 0.58-0.97); 0.79 0.66-0.95) (Pinteraction = 0.49). Consistent observed for hospitalization, death, all-cause mortality, improvement KCCQ-TSS.In DELIVER, beneficial placebo clinical events symptoms consistent, irrespective type at baseline. Failure. [DELIVER]; NCT03619213).