Dapagliflozin in Patients with Heart Failure and Previous Myocardial Infarction: A Participant-Level Pooled Analysis of DAPA-HF and DELIVER

Mar 15, 2024European journal of heart failure

Dapagliflozin in heart failure patients with past heart attacks: Combined analysis of two clinical trials

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Abstract

Of the 11,007 patients studied, 3,731 (34%) had a previous myocardial infarction (MI) and were at higher risk of adverse outcomes.

Patients with a history of MI faced a higher risk of cardiovascular death or worsening heart failure compared to those without MI.
Dapagliflozin reduced the risk of the primary outcome in patients both with and without a history of MI.
The hazard ratio for the primary outcome in patients with previous MI was 0.83, while it was 0.76 for those without MI, indicating similar benefits from dapagliflozin.
Key secondary outcomes also showed consistent benefits from dapagliflozin in both groups.
Serious adverse events did not occur more frequently with dapagliflozin, regardless of MI history.

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AIMS: Patients with heart failure (HF) and history of myocardial infarction (MI) face a higher risk of disease progression and clinical events. Whether sodium-glucose cotransporter 2 inhibitors may modify clinical trajectory in such individuals remains incompletely understood.

METHODS AND RESULTS: The DAPA-HF and DELIVER trials compared dapagliflozin with placebo in patients with symptomatic HF with left ventricular ejection fraction (LVEF) ≤40% and > 40%, respectively. In this pooled participant-level analysis, we assessed efficacy and safety outcomes by history of MI. The primary outcome in both trials was the composite of cardiovascular death or worsening HF. Of the total of 11 007 patients, 3731 (34%) had a previous MI and were at higher risk of the primary outcome across the spectrum of LVEF in covariate-adjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02-1.24). Dapagliflozin reduced the risk of the primary outcome to a similar extent in patients with (HR 0.83, 95% CI 0.72-0.96) and without previous MI (HR 0.76, 95% CI 0.68-0.85; p = 0.36), with consistent benefits on key secondary outcomes as well. Serious adverse events did not occur more frequently with dapagliflozin, irrespective of previous MI. interaction

CONCLUSION: History of MI confers increased risks of adverse cardiovascular outcomes in patients with HF across the LVEF spectrum, even among those with preserved ejection fraction. Dapagliflozin consistently and safely reduces the risk of cardiovascular death or worsening HF, regardless of previous MI.

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Dapagliflozin in Patients with Heart Failure and Previous Myocardial Infarction: A Participant-Level Pooled Analysis of DAPA-HF and DELIVER

Abstract

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