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Effects of dapagliflozin in heart failure with reduced ejection fraction, and chronic obstructive pulmonary disease: an analysis of DAPA-HF

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  • Pooja Dewan
  • Kieran F Docherty
  • Olof Bengtsson
  • Rudolf A de Boer
  • Akshay S Desai
  • Jaroslaw Drozdz
  • Nathaniel M Hawkins
  • Silvio E Inzucchi
  • Masafumi Kitakaze
  • Lars Køber
  • Mikail N Kosiborod
  • Anna Maria Langkilde
  • Daniel Lindholm
  • Felipe A Martinez
  • Béla Merkely
  • Mark C Petrie
  • Piotr Ponikowski
  • Marc S Sabatine
  • Morten Schou
  • Mikaela Sjöstrand
  • Scott D Solomon
  • Subodh Verma
  • Pardeep S Jhund
  • John J V McMurray
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AIMS: Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure (HF) with reduced ejection fraction (HFrEF), associated with worse outcomes and often suboptimal treatment because of under-prescription of beta-blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. The aim of this study was to examine outcomes related to COPD in a post hoc analysis of the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial.

METHODS AND RESULTS: We examined whether the effects of dapagliflozin in DAPA-HF were modified by COPD status. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. Overall, 585 (12.3%) of the 4744 patients randomized had a history of COPD. Patients with COPD were more likely to be older men with a history of smoking, worse renal function, and higher baseline N-terminal pro B-type natriuretic peptide, and less likely to be treated with a beta-blocker or mineralocorticoid receptor antagonist. The incidence of the primary outcome was higher in patients with COPD than in those without [18.9 (95% confidence interval 16.0-22.2) vs. 13.0 (12.1-14.0) per 100 person-years; hazard ratio (HR) for COPD vs. no COPD 1.44 (1.21-1.72); P < 0.001]. The effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with [HR 0.67 (95% confidence interval 0.48-0.93)] and without COPD [0.76 (0.65-0.87); interaction P-value 0.47].

CONCLUSIONS: In DAPA-HF, one in eight patients with HFrEF had concomitant COPD. Participants with COPD had a higher risk of the primary outcome. The benefit of dapagliflozin on all pre-specified outcomes was consistent in patients with and without COPD.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03036124.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Volume23
Issue number4
Pages (from-to)632-643
Number of pages12
ISSN1388-9842
DOIs
Publication statusPublished - Apr 2021

    Research areas

  • Chronic obstructive pulmonary disease, Dapagliflozin, Heart failure

ID: 62247157