Dapagliflozin in Patients with Heart Failure and Reduced Eje
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In patients with type 2 diabetes, inhibitors of sodium–glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms.

In this phase 3, placebo-controlled trial, researchers randomly assigned 4744 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death.

Results: Over a median of 18.2 months, the primary outcome occurred in 386 of 2373 patients in the dapagliflozin group and in 502 of 2371 patients in the placebo group. A first worsening heart failure event occurred in 237 patients in the dapagliflozin group and in 326 patients in the placebo group. Death from cardiovascular causes occurred in 227 patients in the dapagliflozin group and in 273 patients in the placebo group; 276 patients and 329 patients, respectively, died from any cause. Findings in patients with diabetes were similar to those in patients without diabetes. The frequency of adverse events related to volume depletion, renal dysfunction, and hypoglycemia did not differ between treatment groups.

Conclusively, Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303
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