Dapagliflozin reduces risk of sudden cardiac death, ventricular arrhythmia in HFrEF patients: Study
UK: A recent study has found that dapagliflozin when added to conventional therapy in HFrEF patients reduces the risk of cardiac arrest, any serious ventricular arrhythmia, or sudden death. The study is published in the European Heart Journal.
Recently, SGLT2 inhibitors have been shown to reduce both death and worsening heart failure from cardiovascular causes in patients with heart failure and reduced ejection fraction (HFrEF). Ventricular arrhythmias are common and one of the main causes of death in HFrEF. With improving pharmacological therapy, although the rates of sudden death have reduced over the past three decades. Still, this mode of death remains the principal mortality cause in ambulatory patients with HFrEF, particularly those with mild symptoms.
Considering the above, the researchers felt the need to investigate the effect of new therapies for HFrEF on ventricular arrhythmias and mode of death, including sudden death. Various proposed actions of SGLT2 inhibitors raise the hypothesis that these might reduce the risk of ventricular arrhythmias.
Therefore, to investigate the hypothesis that SGLT2 inhibition reduces the risk of ventricular arrhythmias, James P Curtain, University of Glasgow, Scotland, UK, and colleagues undertook a post hoc analysis of DAPA-HF, examining serious adverse event (SAE) reports of ventricular arrhythmias, resuscitated cardiac arrest, and sudden death according to randomized assignment to dapagliflozin or placebo in HFrEF patients.
The research yielded the following findings:
- A serious ventricular arrhythmia was reported in 2.4% of the 4744 patients in DAPA-HF (ventricular fibrillation in 15 patients, ventricular tachycardia in 86, 'other' ventricular arrhythmia/tachyarrhythmia in 12, and torsade de pointes in 2 patients).
- A total of 41% of the 500 cardiovascular deaths occurred suddenly. Eight patients survived resuscitation from cardiac arrest.
- Independent predictors of the composite outcome (the first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest or sudden death), ranked by chi-square value, were log-transformed N-terminal pro-B-type natriuretic peptide, history of ventricular arrhythmia, left ventricular ejection fraction, systolic blood pressure, history of myocardial infarction, male sex, body mass index, serum sodium concentration, non-white race, treatment with dapagliflozin, and cardiac resynchronization therapy.
- Of participants assigned to dapagliflozin, 5.9% patients experienced the composite outcome compared with 7.4% patients in the placebo group [hazard ratio 0.79], and the effect was consistent across each of the components of the composite outcome.
The researchers concluded that "dapagliflozin, compared with placebo, reduced the incidence of investigator-reported (but not adjudicated) ventricular arrhythmias in patients with HFrEF, most of whom were treated with a renin–angiotensin system blocker, beta-blocker, and an MRA as well."
Reference:
The study titled, "Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF," is published in the European Heart Journal.
DOI: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab560/6358075#292213231
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