Background: Practice guidelines recommend Sodium-glucose co-transporter-2 inhibitors (SGLT2-i) for patients with heart failure with reduced ejection fraction (HFrEF). Our study aimed to describe our population of patients with indications for Dapagliflozin, to compare it with the DAPA-HF trial population and assess the possible prognostic evolution.
Methods: We retrospectively analysed clinical data of the first 100 HFrEF patients treated with Dapagliflozin at our heart failure clinic (Centro Cardiologico Monzino) from September 2021.
Results: Table 1 shows patient characteristics in our study (n = 100) and in the DAPA-HF trial (n = 2373). Our patients had a mean age of 69±11 years, mean left ventricular ejection fraction of 31,1±8,0%, New York Heart Association class II (78%), class III (21%) and class IV (1%). 64% of our patients performed cardiopulmonary exercise test (CPET), with mean peak VO2/kg of 14,3±4,5 ml/min/kg and mean VE/VCO2 slope of 39,1±10,5. In our study, compared to the DAPA-HF trial population, there were fewer diabetic patients (14,1% vs 41,8%, p < 0,001), a larger number of patients with implanted cardioverter defibrillator (ICD) (59,6% vs 26,2%, p < 0,001) and cardiac resynchronization therapy (CRT) (22,2% vs 8,0%, p < 0,001). Furthermore, our population had a higher percentage of patients already on optimised therapy with Sacubitril/Valsartan (86,9% vs 10,5%, p < 0,001) and mineralocorticoid receptor antagonists (82,8% vs 71,5%, p < 0,001), along with beta-blockers (97,9% vs 96%, p = 0,434).
Conclusions: Our patients were slightly older and frailer than those in the pivotal DAPA-HF trial and probably at a more advanced stage of the disease as suggested by the higher prevalence of ICD/CRT and Sacubitril/Valsartan. Based on these results, it may be that the expected prognostic benefit of adding Dapagliflozin to their therapy, in terms of absolute risk, will be lower than in the DAPA-HF trial. Future studies and a longer follow-up are needed to compare death and hospitalisation rates.