Aims Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart
failure (HF) with reduced ejection fraction (HFrEF), associated with worse outcomes
and often suboptimal treatment because of under-prescription of beta-blockers. Consequently,
additional effective therapies are especially relevant in patients with COPD. The
aim of this study was to examine outcomes related to COPD in a post hoc analysis of
the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial.
Methods and results We examined whether the effects of dapagliflozin in DAPA-HF were
modified by COPD status. The primary outcome was the composite of an episode of worsening
HF or cardiovascular death. Overall, 585 (12.3%) of the 4744 patients randomized had
a history of COPD. Patients with COPD were more likely to be older men with a history
of smoking, worse renal function, and higher baseline N-terminal pro B-type natriuretic
peptide, and less likely to be treated with a beta-blocker or mineralocorticoid receptor
antagonist. The incidence of the primary outcome was higher in patients with COPD
than in those without [18.9 (95% confidence interval 16.0-22.2) vs. 13.0 (12.1-14.0)
per 100 person-years; hazard ratio (HR) for COPD vs. no COPD 1.44 (1.21-1.72); P <
0.001]. The effect of dapagliflozin, compared with placebo, on the primary outcome,
was consistent in patients with [HR 0.67 (95% confidence interval 0.48-0.93)] and
without COPD [0.76 (0.65-0.87); interaction P-value 0.47]. Conclusions In DAPA-HF,
one in eight patients with HFrEF had concomitant COPD. Participants with COPD had
a higher risk of the primary outcome. The benefit of dapagliflozin on all pre-specified
outcomes was consistent in patients with and without COPD. Clinical Trial Registration:
ClinicalTrials.gov ID NCT03036124.
