Dapagliflozin in Black and White Patients With HF: Analysis of the DAPA-HF and DELIVER Trials

The absolute benefits of the SGLT2 inhibitor dapagliflozin is greater in Black patients in part due to having a higher incidence and prevalence of heart failure (HF), but the relative benefits are consistent in both Black and White patients, according to a study published April 3 in JACC: Heart Failure.

Jawad H. Butt, MD, et al., conducted a pooled analysis of two trials comparing dapagliflozin to placebo, DAPA-HF in patients with HF with reduced ejection fraction (HFrEF) and DELIVER in patients with HF and mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF), to examine outcomes and responses to treatment in Black and White patients. Of the 3,526 patients randomized in the trials, 381 (10.8%) identified as Black and 2,626 (74.5%) identified as White. The primary outcome was the composite of worsening HF or cardiovascular death.

Results showed that the primary outcome occurred at a rate of 16.8% per 100 person-years (95% CI, 13.8-20.4) in Black patients and 11.6% per 100 person-years (95% CI, 10.6-12.7) in White patients (adjusted hazard ratio [HR], 1.27; 95% CI, 1.01-1.59). When compared with placebo, dapagliflozin decreased the primary endpoint virtually the same in Black (HR, 0.69; 95% CI, 0.47-1.02) and White patients (HR, 0.73 [95% CI, 0.61-0.88]; p for interaction = 0.73). The number of patients needed to treat with dapagliflozin to prevent one event over the median follow-up was 12 in Black patients and 17 in White patients.

The authors note that the data show the substantial and clinically important benefits of dapagliflozin in patients with HF across the spectrum of EF regardless of race but that “failure to prescribe novel therapies with proven efficacy in high-risk populations will only serve to exacerbate preexisting health care disparities” and that we must make an effort to ensure equitable use of these novel therapies. 

In an accompanying editorial comment, Ersilia M. DeFilippis, MD, FACC, and Ruben A. Salazar, MD, added that “ it is imperative to ensure that Black patients are not unnecessarily excluded from eligibility for these therapies” and that ongoing efforts to improve the recruitment and inclusion of Black patients in clinical trials is crucial.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Lipid Metabolism, Acute Heart Failure

Keywords: Randomized Controlled Trials as Topic, Ventricular Dysfunction, Left, Follow-Up Studies, Incidence, Prevalence, Sodium-Glucose Transporter 2, Stroke Volume, Heart Failure, Sodium-Glucose Transporter 2 Inhibitors

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