TY - JOUR
T1 - Heart failure, chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction
T2 - Insights from DELIVER
AU - Butt, Jawad H
AU - Lu, Henri
AU - Kondo, Toru
AU - Bachus, Erasmus
AU - de Boer, Rudolf A
AU - Inzucchi, Silvio E
AU - Jhund, Pardeep S
AU - Kosiborod, Mikhail N
AU - Lam, Carolyn S P
AU - Martinez, Felipe A
AU - Vaduganathan, Muthiah
AU - Solomon, Scott D
AU - McMurray, John J V
N1 - This article is protected by copyright. All rights reserved.
PY - 2023/11
Y1 - 2023/11
N2 - AIM: Chronic obstructive pulmonary disease (COPD) is common in heart failure with a mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and is associated with worse outcomes. In a pre-specified analysis of DELIVER, we investigated the relationship between COPD status and outcomes, and the efficacy and safety of dapagliflozin, compared with placebo, according to COPD status.METHODS AND RESULTS: Patients with severe pulmonary disease (including COPD) were excluded from the trial. The primary outcome was a composite of cardiovascular death or worsening heart failure. Of the 6261 patients with data on baseline COPD status, 694 (11.1%) had a known history of this condition. The risk of the primary endpoint was higher in patients with mild-to-moderate COPD compared with those without COPD (adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.08-1.51). The benefit of dapagliflozin on the primary outcome was consistent irrespective of COPD status (no COPD: HR 0.82 [95% CI 0.72-0.93]; COPD: HR 0.82 [95% CI 0.62-1.10]; p
interaction = 0.98). Consistent effects were observed for heart failure, cardiovascular, and all-cause hospitalization, and deaths, and composites of these. Dapagliflozin, as compared with placebo, improved the Kansas City Cardiomyopathy Questionnaire scores from baseline to 8 months to a similar extent in patients with and without mild-to-moderate COPD (p
interaction ≥ 0.63). Adverse events and treatment discontinuation were not more frequent with dapagliflozin than with placebo irrespective of COPD status.
CONCLUSIONS: Mild-to-moderate COPD is common in patients with HFmrEF/HFpEF and is associated with worse outcomes. The beneficial effects of dapagliflozin compared with placebo on clinical events and symptoms were consistent, regardless of COPD status.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03619213.
AB - AIM: Chronic obstructive pulmonary disease (COPD) is common in heart failure with a mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and is associated with worse outcomes. In a pre-specified analysis of DELIVER, we investigated the relationship between COPD status and outcomes, and the efficacy and safety of dapagliflozin, compared with placebo, according to COPD status.METHODS AND RESULTS: Patients with severe pulmonary disease (including COPD) were excluded from the trial. The primary outcome was a composite of cardiovascular death or worsening heart failure. Of the 6261 patients with data on baseline COPD status, 694 (11.1%) had a known history of this condition. The risk of the primary endpoint was higher in patients with mild-to-moderate COPD compared with those without COPD (adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.08-1.51). The benefit of dapagliflozin on the primary outcome was consistent irrespective of COPD status (no COPD: HR 0.82 [95% CI 0.72-0.93]; COPD: HR 0.82 [95% CI 0.62-1.10]; p
interaction = 0.98). Consistent effects were observed for heart failure, cardiovascular, and all-cause hospitalization, and deaths, and composites of these. Dapagliflozin, as compared with placebo, improved the Kansas City Cardiomyopathy Questionnaire scores from baseline to 8 months to a similar extent in patients with and without mild-to-moderate COPD (p
interaction ≥ 0.63). Adverse events and treatment discontinuation were not more frequent with dapagliflozin than with placebo irrespective of COPD status.
CONCLUSIONS: Mild-to-moderate COPD is common in patients with HFmrEF/HFpEF and is associated with worse outcomes. The beneficial effects of dapagliflozin compared with placebo on clinical events and symptoms were consistent, regardless of COPD status.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03619213.
KW - Chronic obstructive pulmonary disease
KW - Clinical trial
KW - Dapagliflozin
KW - Heart failure
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=85169422300&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3000
DO - 10.1002/ejhf.3000
M3 - Journal article
C2 - 37634087
SN - 1388-9842
VL - 25
SP - 2078
EP - 2090
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 11
ER -