Prognosis of patients eligible for dapagliflozin in acute heart failure

• DOI: 10.1111/eci.13245
• Publication Date: 2020-04-19T19:54:40Z
• Authors: Sebastian Carballo; Jérôme Stirnemann; Nicolas Garin; Pauline Darbellay...; Jacques Serratrice; David Carballo
• Keywords: Male; Eligibility Determination; Sodium-Glucose Transporter 2 Inhibitors / therapeutic use; Patient Readmission; Glucosides / therapeutic use; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Glucosides; info:eu-repo/classification/ddc/616; Heart Failure / physiopathology; Cause of Death; Humans; Heart Failure / therapy; Prospective Studies; Benzhydryl Compounds; Mortality; Heart Failure / metabolism; Randomized Controlled Trials as Topic; Aged; Proportional Hazards Models; ddc:616; Aged, 80 and over; Heart Failure; Acute heart failure; Stroke Volume; Dapagliflozin; Middle Aged; Prognosis; 3. Good health; Hospitalization; Benzhydryl Compounds / therapeutic use; Acute Disease; Multivariate Analysis; Female; Patient Readmission / statistics & numerical data

AbstractBackgroundDapagliflozin, a sodium‐glucose cotransporter 2 inhibitor, was shown in the DAPA‐HF study to reduce the risk of worsening heart failure or death in symptomatic patients with left ejection fraction <40%, irrespective of diabetes. The aim of this study was to evaluate eligibility status for dapagliflozin in non‐selected patients hospitalized for acute decompensated heart failure (ADHF), as well as prognostic implications of this status.Materials and methodsAnalysis of 815 patients recruited in a prospective cohort of acute heart failure at the University Hospitals of Geneva, consisting of consecutive patients admitted with ADHF. Eligibility for dapagliflozin was determined using criteria described DAPA‐HF.ResultsOf 815 patients, 220 (27%) were eligible for dapagliflozin treatment. In survival analysis, patients who were eligible for dapagliflozin had better clinical outcomes with respect to all‐cause mortality and rehospitalization as compared to those who were not eligible. In multivariate analysis, the hazard ratio for all‐cause mortality or readmission in patients eligible for dapagliflozin was 0.82 (95% CI 0.68‐0.999, P = .049) as compared to the non‐eligible.ConclusionsUsing DAPA‐HF criteria, only 27% of non‐selected patients admitted for ADHF are theoretically eligible for dapagliflozin. This eligibility for dapagliflozin is associated with better outcomes. Further evaluation of the benefits of dapagliflozin in selected HF patients may be of interest. This may have implications for selection criteria in future randomized effectiveness studies.