DAPA-HF Analyses Look at Benefit of Dapagliflozin Across Age Groups and Health Status

Dapagliflozin improved symptoms and reduced the risk of cardiovascular death and worsening heart failure events in all ages of patients with heart failure and reduced ejection fraction (HFrEF) in the DAPA-HF trial. The new results were presented Nov. 17 during AHA 2019 in Philadelphia, PA and simultaneously published in Circulation.

Felipe A. Martinez, MD, and Matteo Serenelli, MD, et al., looked at the effects of 10 mg once daily of dapagliflozin vs. placebo according to age in 4,744 pages ages 22-94 with HFrEF. 636 patients were less than 55 years old (13.4 percent), 1,242 were ages 55-64 (26.2 percent), 1,717 were ages 65-74 (36.2 percent), and 1,149 were 75 years or older (24.2 percent).

Results showed that the rate of the primary outcome – a composite of an episode of worsening heart failure or cardiovascular death – in each age group in the placebo group was 13.6, 15.7, 15.1, and 18.0 vs. the dapagliflozin group: 11.8, 11.4, 11.4, 12.6.

The authors conclude that "dapagliflozin was well tolerated, with no significant difference between dapagliflozin and placebo in any age group." Further, they explain that the effects were consistent "both in terms of efficacy and safety." They add that moving forward, "our data clearly show that dapagliflozin has substantial, clinically important, benefits in older as well as younger patients."

In a separate analysis of the DAPA-HF trial also presented Nov. 17 during AHA 2019 and simultaneously published in Circulation, Mikhail N. Kosiborod, MD, FACC, and Pardeep Jhund, MD, PhD, et al., examined the effects of dapagliflozin vs. placebo across the range of health status and found that treatment with dapagliflozin "reduced death and HF hospitalization … and improved symptom burden, functional status and quality of life in patients with HFrEF."

The investigators looked at 4,443 patients with available Kansas City Cardiomyopathy Questionnaire (KCCQ) data. Results showed the effects of dapagliflozin vs. placebo were consistent across the range of KCCQ total symptom score data in terms of reducing cardiovascular death and worsening heart failure. In addition, patients treated with dapagliflozin had "greater improvement" in mean KCCQ total symptom score, clinical summary score and overall summary score at 8 months.

The authors conclude that "dapagliflozin significantly increased the proportion of patients experiencing small, moderate and large improvements in health status" and that "these effects were clinically important."

Keywords: AHA19, AHA Annual Scientific Sessions, Heart Failure, Dyslipidemias, Cardiomyopathies

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