ACC House Call: Dapagliflozin for Heart Failure

Supplementary findings in the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) trial program showed the cardiometabolic therapy is associated with reduced heart failure (HF) event risk—both initially and recurrently—over 18 months.

The SGLT2 inhibitor was shown to significantly reduce composite HF hospitalizations or cardiovascular-related deaths versus placebo, as presented virtually at the ACC.20 Together with Word Congress of Cardiology (ACC/WCC) Scientific Sessions by Piotr Ponikowski, MD, PhD, of the Center for Heart Disease at University Hospital, Medical University in Wroclaw, Poland.

Ponikowski and colleagues showed dapagliflozin (Farxiga) has benefit beyond time-to-first event risk reduction—a more common metric in HF care, despite the fact that many patients with HF have continued, worsening risk for events after the initial one.

“Time-to-first event may also overestimate treatment benefit if effect wanes over time, or if a subset of patients does not respond to therapy and experiences recurrent events,” investigators wrote.

The newest data for the SGLT2 inhibitors adds to the portfolio of what was once just a promising agent for patients with diabetes and no glycemic control—type 2 diabetes, renal outcomes, and now heart failure event risk reduction are all becoming proven capable for dapagliflozin.

And that changes the mindset of the entire care team, Sanjeev Gulati, MD, FACC, said.

“This is not just a therapy for diabetes, this a therapy now for heart failure patients,” Gulati explained. “And the subtext of that is really now, a heart failure specialist, general cardiologist who takes care of heart failure, and definitely the primary care doctors who manage diabetes, need to start thinking of these patients in a very different way.”

In an interview with HCPLive® regarding the new DAPA-HF findings and the overall potential of dapagliflozin, Gulati, chief of Cardiology at Sanger Heart and Vascular Institute, explained the shifting paradigm of care associated with SGLT2 inhibitors and how their investigated benefit for cardiovascular outcomes will progress.