Effects of Dapagliflozin on Symptoms, Function and Quality of Life in Patients with Heart Failure and Reduced Ejection Fraction

Kosiborod, Mikhail N; Jhund, Pardeep; Docherty, Kieran F; Diez, Mirta; Petrie, Mark C; Verma, Subodh; Nicolau, Jose C; Merkely, Béla [Merkely, Béla Péter (Kardiológia), szerző] Városmajori Szív- és Érgyógyászati Klinika (SE / AOK / K); Kardiológia Központ - Kardiológiai Tanszék (SE / AOK / K); Sportorvostan Tanszék (SE / AOK / K); Kitakaze, Masafumi; DeMets, David L; Inzucchi, Silvio E; Køeber, Lars; Martinez, Felipe A; Ponikowski, Piotr; Sabatine, Marc S; Solomon, Scott D; Bengtsson, Olof; Lindholm, Daniel; Niklasson, Anna; Sjöstrand, Mikaela; Langkilde, Anna Maria; McMurray, John J V

Angol nyelvű Szakcikk (Folyóiratcikk) Tudományos
Megjelent: CIRCULATION 0009-7322 1524-4539 141 (2) pp. 90-99 2020
  • SJR Scopus - Cardiology and Cardiovascular Medicine: D1
Azonosítók
Background: Goals of management in patients with heart failure and reduced ejection fraction (HFrEF) include reducing death and hospitalizations, and improving health status (symptoms, physical function and quality of life). In the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial, sodium-glucose cotransporter-2 inhibitor, dapagliflozin, reduced death and hospitalizations, and improved symptoms in patients with HFrEF. In this analysis, we examine the effects of dapagliflozin on a broad range of health status outcomes, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: KCCQ was evaluated at randomization, 4 and 8 months. Patients were divided by baseline KCCQ total symptom score (TSS); Cox proportional hazards models examined the effects of dapagliflozin on clinical events across these subgroups. We also evaluated the effects of dapagliflozin on KCCQ-TSS, clinical summary score (CSS) and overall summary score (OSS). Responder analyses were performed to compare proportions of dapagliflozin vs. placebotreated patients with clinically meaningful changes in KCCQ at 8 months. Results: 4443 patients had available KCCQ at baseline (median KCCQ-TSS 77.1 [IQR 58.3-91.7]). The effects of dapagliflozin versus placebo on reducing cardiovascular death or worsening HF were consistent across the range of KCCQ-TSS (lowest to highest tertile: HR (95% CI) 0.70 (0.57-0.86); 0.77 (0.61-0.98); 0.62 (0.46-0.83); P for heterogeneity=0.52). Patients treated with dapagliflozin had greater improvement in mean KCCQ-TSS, -CSS and - OSS at 8 months (2.8, 2.5 and 2.3 points higher vs. placebo; P <0.0001 for all). Fewer patients treated with dapagliflozin had a deterioration in KCCQ-TSS (OR 0.84, 95% CI 0.78-0.90; P<0.0001); and more patients had at least small, moderate and large improvements (OR, 95% CI: 1.15, 1.08-1.23; 1.15 (1.08-1.22); 1.14 (1.07-1.22); number-needed-to-treat=14, 15 and 18, respectively; P<0.0001 for all; results consistent for KCCQ-CSS and -OSS). Conclusions:Dapagliflozin reduced cardiovascular death and worsening HF across the range of baseline KCCQ, and improved symptoms, physical function and quality of life in patients with HFrEF. Furthermore, dapagliflozin increased the proportion of patients experiencing at least small, moderate and large improvements in health status; these effects were clinically important. Clinical Trial Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT03036124.
Hivatkozás stílusok: IEEEACMAPAChicagoHarvardCSLMásolásNyomtatás
2024-07-17 14:51