Dapagliflozin associated with improved outcomes in heart failure patients regardless of frailty

A post-hoc analysis of the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) randomized control trial found that dapagliflozin improved outcomes in heart failure patients regardless of frailty, with reductions being largest among more frail patients.

According to the authors, these findings are important considering the common reluctance of clinicians to introduce medications to patients that are perceived to be frail. The analysis is published in Annals of Internal Medicine.

Frailty is clinically defined as a state of increased vulnerability related to decline in reserve and function across multiple physiologic systems such that the ability to cope with stressors is comprised.

Frailty is associated with a higher likelihood of heart failure and frail patients with heart failure have a higher risk for death, hospitalizations, and functional decline. Thus, frailty reduction is an important goal in the holistic management of heart failure.

Researchers from the University of Glasgow used the Rockwood cumulative deficit approach to investigate the efficacy of dapagliflozin according to frailty status in a post-hoc analysis of the DAPA-HF trial. DAPA-HF previously demonstrated that dapagliflozin, compared with placebo, reduced the risk for worsening heart failure events and death and improved symptoms when added to standard therapy.

The analysis showed that 50 percent of the patients included in DAPA-HF were frail, and frailty was associated with more impairment in health status and worse clinical outcomes, including hospitalization. The authors also found that the use of dapagliflozin substantially reduced risk for worsening heart failure events and death and was associated with improved symptoms, physical function, and quality of life, regardless of frailty.

DOI: https://www.acpjournals.org/doi/10.7326/M21-4776