Effects of Dapagliflozin According to the Heart Failure Collaboratory Medical Therapy Score: Insights From DAPA-HF

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  • Jawad H. Butt
  • Pooja Dewan
  • Ersilia M. DeFilippis
  • Biering-Sørensen, Tor
  • Kieran F. Docherty
  • Pardeep S. Jhund
  • Mikhail N. Kosiborod
  • Felipe A. Martinez
  • Olof Bengtsson
  • Niklas Dyrby Johansen
  • Anna Maria Langkilde
  • Mikaela Sjöstrand
  • Muthiah Vaduganathan
  • Scott D. Solomon
  • Marc S. Sabatine
  • Køber, Lars Valeur
  • Mona Fiuzat
  • John J.V. McMurray

Background: The Heart Failure Collaboratory (HFC) has developed a score integrating classes and doses of guideline-directed medical therapies prescribed for patients with heart failure (HF) and reduced ejection fraction. One potential use of this score is to test whether new treatments demonstrate incremental benefits, even in patients receiving comprehensive guideline-directed medical therapy. Objectives: The authors investigated the efficacy of dapagliflozin according to a modified HFC score in the DAPA-HF (Dapagliflozin And Prevention of Adverse outcomes in Heart Failure) trial. Methods: In DAPA-HF, 4,744 patients with HF and reduced ejection fraction were randomized to dapagliflozin or placebo. The modified HFC score accounted for race and electrocardiogram rhythm and rate, with a maximum possible score of 100%. The primary outcome was the composite of worsening HF or cardiovascular death. Results: The median modified HFC score was 50% (IQR: 27.5%-62.5%; range 0%-100%). Compared with the lowest tertile, the highest tertile of the treatment score was associated with a lower risk of worsening HF or cardiovascular death (tertile 1, reference; tertile 2, HR: 0.97 [95% CI: 0.82-1.14]; tertile 3, HR: 0.83 [95% CI: 0.70-0.99]). Dapagliflozin reduced the risk of worsening HF or cardiovascular death, irrespective of treatment score (the HRs for dapagliflozin vs placebo from tertile 1 to 3 were: 0.76 [95% CI: 0.61-0.94], 0.76 [95% CI: 0.60-0.97], and 0.71 [95% CI: 0.55-0.90]), respectively; Pinteraction = 0.89). Consistent benefits were observed for HF hospitalization, cardiovascular death, all-cause mortality, and improvement in the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ-TTS). Conclusions: Dapagliflozin, compared with placebo, improved all outcomes examined, regardless of the modified HFC score. This score can be easily calculated in clinical trials and used to evaluate the incremental effects of new treatments. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124)

OriginalsprogEngelsk
TidsskriftJACC: Heart Failure
Vol/bind10
Udgave nummer8
Sider (fra-til)543-555
ISSN2213-1779
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
The DAPA-HF trial was funded by AstraZeneca. Dr Butt has received advisory board honoraria from Bayer outside of the submitted work. Dr DeFilippis has served as a steering committee member of the Amgen financed GALACTIC-HF trial; has served on the Board of Sanofi Pasteur; has served on the advisory board of Amgen; has received speaker honoraria from Novartis and Sanofi Pasteur; has received research grants from GE Healthcare and Sanofi Pasteur; and has served as Steering Committee Chair of the Sanofi Pasteur financed DANFLU trial program. Dr Biering-Sørensen has served as a Steering Committee member of the Amgen financed GALACTIC-HF trial; has served on the advisory board of Sanofi Pasteur and Amgen; has received speaker honoraria from Novartis and Sanofi Pasteur; has received research grants from GE Healthcare and Sanofi Pasteur; and has served as Steering Committee Chair of the Sanofi Pasteur financed DANFLU trial program. Dr Docherty’s employer, the University of Glasgow, has been remunerated for his work relating to DAPA-HF; and he has received speaker fees from AstraZeneca. Dr Jhund has received speaker fees, advisory board fees, and funding for work on clinical trials from Novartis and AstraZeneca; has received advisory board fees and a research grant from Boehringer Ingelheim; has worked on clinical trials for NovoNordisk and Bayer; and has received research funding from Analog Devices Inc. Dr Kosiborod has served as a consultant for Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Esperion Therapeutics, and Janssen; and has received research grants from AstraZeneca and Boehringer Ingelheim. Dr Martinez has received an honorarium from AstraZeneca. Dr Bengtsson is an employee of AstraZeneca. Drs Langkilde and Sjöstrand are employees of and have stock holdings in AstraZeneca. Dr Vaduganathan has received research grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lilly, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, Theracos, anUS2.AI; and has consulted for Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, Sarepta, Lexicon, Anacardio, Akros, and Puretech Health. Dr Solomon has consulted for Althera, Amgen, Anthos Therapeutics, AstraZeneca, Beren Therapeutics, Bristol-Myers Squibb, DalCor, Dr Reddy’s Laboratories, Fibrogen, Intarcia, Merck, Moderna, Novo Nordisk, and Silence Therapeutics; and has received research grant support through Brigham and Women’s Hospital from Abbott, Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Daiichi Sankyo, Eisai, Intarcia, Ionis, The Medicines Company, MedImmune, Merck, Novartis, Pfizer, and Quark Pharmaceuticals. Dr Sabatine has served as a consultant for Althera, Amgen, Anthos Therapeutics, AstraZeneca, Beren Therapeutics, Bristol-Myers Squibb, DalCor, Dr Reddy’s Laboratories, Fibrogen, Intarcia, Merck, Moderna, Novo Nordisk, and Silence Therapeutics; and has received research grant support through Brigham and Women’s Hospital from Abbott, Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Daiichi Sankyo, Eisai, Intarcia, Ionis, Medicines Company, MedImmune, Merck, Novartis, Pfizer, and Quark Pharmaceuticals. Dr Køber has received speaker’s honoraria from Novo Novartis, AstraZeneca, and Boehringer. Prof McMurray is supported by British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217; his employer, Glasgow University, has been paid by AstraZeneca (who markets dapagliflozin) for his time spent as principal investigator of DAPA-HF and co-principal investigator of DELIVER and DETERMINE (trials using dapagliflozin) in heart failure and meetings and other activities related to these trials; by Amgen for his time spent as Steering Committee member for the ATOMIC-HF and COSMIC-HF trials and meetings related to these trials; by Cytokinetics for his time spent as Steering Committee member for the ATOMIC-HF, COSMIC-HF, and GALACTIC-HF trials and meetings and other activities related to these trials; by Bayer for his time spent as Steering Committee member for the PANACHE trial using neladenoson bialanate and for the FINEARTS trial with finerenone; by Theracos for his time spent as principal investigator for the BEST trial and meetings related to this trial; by GlaxoSmithKline for his time spent as co-principal investigator and Steering Committee member, respectively, for the Harmony-Outcomes trial (albiglutide) and 2 trials, ASCEND-D and ASCEND-ND, using daprodustat, and meetings related to these trials; by Cardurion for his participation in a company advisory board about development of a PDE 9 inhibitor in heart failure; by Novartis for his time spent as Executive Committee member and then co-principal investigator of ATMOSPHERE, co-principal investigator of the PARADIGM-HF and PARAGON-HF trials and Executive/Steering Committee member for PARADISE-MI, PERSPECTIVE and PARACHUTE-HF trials (with sacubitril/valsartan) and meetings/presentations related to these trials and aliskiren and sacubitril/valsartan; by KBP Biosciences for my time spent scientific advisor to company to help guide clinical development in cardio-renal disease, inflammation and infection; by Bristol-Myers Squibb for his time spent as a Steering Committee member for the STAND-UP clinical trial (using a HNO donor) in heart failure and meetings related to this trial; by Ionis for his time spent as consultant in services related to Ionis angiotensinogen program; by DalCor Pharmaceuticals for his time spent as Steering Committee member for the Dal-GenE trial and meetings/other activities related to this trial/treatment; and by Boehringer Ingelheim for his participation as a consultant for Empa Pragmatic Trial; AstraZeneca, Amgen, Cytokinetics, Theracos, GlaxoSmithKline, Novartis, KBP Biosciences, and Ionis have also paid his travel and accommodation for some of these meetings; these payments were made through a consultancy with Glasgow University, and he has not received personal payments in relation to these trials/this drug; and he has received personal lecture fees from Abbott, Alkem Metabolics, Eris Lifesciences, Hikma, Lupin, Sun Pharmaceuticals, Medscape/Heart.Org, ProAdWise Communications, Radcliffe Cardiology, Servier, and the Corpus. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2022 American College of Cardiology Foundation

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