Early Dapagliflozin Administration Cuts Heart Failure Admissions, Study Finds

The study, published in The British Journal of Cardiology, revealed that early administration of dapagliflozin notably decreased hospital admissions for heart failure within one year of treatment. However, there were no significant differences in 24-hour urine volume, cardiac death rates, ejection fraction (EF), glomerular filtration rate (GFR), hemoglobin levels, NT-proBNP levels, or side effects.

SGLT2 inhibitors have shown beneficial effects in heart failure (HF) patients. However, the impact of dapagliflozin, specifically in individuals with decompensated HF, is still not well understood. To fill this knowledge gap, Takahiro Tokuda, Interventionist, Nagoya Heart Center, Higashi-ku, Nagoya, Aichi, Japan, and colleagues aimed to compare the safety and efficacy of early and late dapagliflozin administration for decompensated HF.

For this purpose, the researchers analyzed data from 70 patients diagnosed with heart failure at a Japanese heart center between December 2020 and November 2021. They conducted a retrospective study using propensity score matching to compare the clinical outcomes of early versus late dapagliflozin administration for decompensated heart failure.

The primary endpoint focused on hospital admissions for heart failure within one year of starting dapagliflozin. Secondary endpoints included evaluations of 24-hour urine volume, cardiac death, changes in ejection fraction (EF), blood pressure, glomerular filtration rate (GFR), hemoglobin levels, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and side effects over the same period. Ultimately, the analysis included 15 matched pairs of patients.

The researchers reported the following findings:

• Of the 70 patients analyzed, 15 received early dapagliflozin administration, while 55 were given it later.
• After propensity score matching (PSM), 15 matched pairs were included, showing no significant differences in baseline characteristics between the groups.
• The average age of patients was 73 years, with 53% male, 27% having ischemic heart failure, a mean left ventricular ejection fraction of 45%, and a median NT-proBNP level of 4,481 pg/ml.
• The average duration of dapagliflozin treatment was significantly longer in the late group (33.5 ± 17.8 days) compared to the early group (1.7 ± 0.8 days).
• The heart failure admission rate was significantly lower in the early dapagliflozin group (0%) compared to the late group (20%).
• There were no significant differences in 24-hour urine volume, cardiac death, changes in ejection fraction, glomerular filtration rate, hemoglobin levels, or NT-proBNP levels within one year.
• The incidence of side effects was similar between both groups, with only one case of dehydration noted in the late-administration group.

The researchers noted several limitations, including a small patient cohort and its retrospective design, which may introduce selection bias. It focused solely on Japanese patients with decompensated heart failure, limiting generalizability. Additionally, findings are specific to dapagliflozin, necessitating further prospective studies to explore other SGLT2 inhibitors.

"Overall, this study found that early administration of dapagliflozin significantly decreased heart failure admissions within one year of treatment. However, there were no observed differences in ejection fraction, glomerular filtration rate, hemoglobin levels, NT-proBNP levels, or side effects," the researchers concluded.

Reference:

DOI: 10.5837/bjc.2024.010