Kondo, T. et al. (2024) Dapagliflozin and days of full health lost through death, hospitalization, and impaired well-being in DAPA-HF. Journal of the American College of Cardiology, 83(20), pp. 1973-1986. (doi: 10.1016/j.jacc.2024.03.385) (PMID:38537918)
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Abstract
Background Conventional time-to-first-event analyses cannot incorporate recurrent hospitalizations and patient well-being in a single outcome. Objectives To overcome this limitation, we tested an integrated measure that includes days lost from death and hospitalization, and additional days of full health lost through diminished well-being. Methods The effect of dapagliflozin on this integrated measure was assessed in the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial, which examined the efficacy of dapagliflozin, compared with placebo, in patients with NYHA functional class II to IV heart failure and a left ventricular ejection fraction ≤40%. Results Over 360 days, patients in the dapagliflozin group (n = 2,127) lost 10.6 ± 1.0 (2.9%) of potential follow-up days through cardiovascular death and heart failure hospitalization, compared with 14.4 ± 1.0 days (4.0%) in the placebo group (n = 2,108), and this component of all measures of days lost accounted for the greatest between-treatment difference (−3.8 days [95% CI: −6.6 to −1.0 days]). Patients receiving dapagliflozin also had fewer days lost to death and hospitalization from all causes vs placebo (15.5 ± 1.1 days [4.3%] vs 20.3 ± 1.1 days [5.6%]). When additional days of full health lost (ie, adjusted for Kansas City Cardiomyopathy Questionnaire–overall summary score) were added, total days lost were 110.6 ± 1.6 days (30.7%) with dapagliflozin vs 116.9 ± 1.6 days (32.5%) with placebo. The difference in all measures between the 2 groups increased over time (ie, days lost by death and hospitalization −0.9 days [−0.7%] at 120 days, −2.3 days [−1.0%] at 240 days, and −4.8 days [−1.3%] at 360 days). Conclusions Dapagliflozin reduced the total days of potential full health lost due to death, hospitalizations, and impaired well-being, and this benefit increased over time during the first year. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure; NCT03036124).
Item Type: | Articles |
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Additional Information: | Drs Jhund and McMurray are supported by a British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217 and the Vera Melrose Heart Failure Research Fund. DAPA-HF was funded by AstraZeneca. |
Keywords: | prognosis, health-related quality of life, heart failure, dapagliflozin, trial |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Kondo, Dr Toru and Docherty, Dr Kieran and Talebi, Dr Atefeh and Jhund, Professor Pardeep and Campbell, Dr Ross and McMurray, Professor John |
Authors: | Kondo, T., Mogensen, U. M., Talebi, A., Gasparyan, S. B., Campbell, R. T., Docherty, K. F., de Boer, R. A., Inzucchi, S. E., Køber, L., Kosiborod, M. N., Martinez, F. A., Sabatine, M. S., Bengtsson, O., Sjöstrand, M., Vaduganathan, M., Solomon, S. D., Jhund, P. S., and McMurray, J. J.V. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Journal of the American College of Cardiology |
Publisher: | Elsevier |
ISSN: | 0735-1097 |
ISSN (Online): | 1558-3597 |
Published Online: | 25 March 2024 |
Copyright Holders: | Copyright: © 2024 The Authors |
First Published: | First published in Journal of the American College of Cardiology 83(20): 1973-1986 |
Publisher Policy: | Reproduced under a Creative Commons licence |
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