DELIVER trial: Cardiovascular benefits of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction

A study published recently in The New England Journal of Medicine (NEJM) reported that treatment with dapagliflozin, a sodium–glucose transporter 2 (SGLT2) inhibitor, reduced the risk of cardiovascular (CV) outcomes in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) >40%.

The interventional study, Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) was a Phase III, double-blind, randomized, placebo-controlled trial and included a total of 6,263 patients with stable HF, LVEF >40%, elevated levels of natriuretic peptides, and evidence of structural heart disease. Concomitant diabetes was reported in 2,806 patients (44.8%). The patients received dapagliflozin 10 mg or matching placebo once daily along with the usually prescribed therapies. The patients were followed up for a median duration of 2.3 years. The two groups were comparable in respect of demographic and baseline clinical characteristics. The efficacy results are as under:

Dapagliflozin was safe and well-tolerated. Patients receiving dapagliflozin had similar incidence of adverse events leading to discontinuation and serious adverse events as those receiving placebo.

Clinical implication: The DELIVER study reports lower risk of worsening HF or CV death with dapagliflozin treatment in patients with HF and a mildly reduced or preserved LVEF. It also highlights the role of SGLT2 inhibition across the LVEF spectrum, as indicated by similar CV outcomes with dapagliflozin treatment in patients with LVEF ≥60% or <60%. These results may be useful in guiding the use of SGLT2 inhibitor in the treatment of patients with HF irrespective of the degree of LVEF and diabetes status.

Source: Solomon SD, McMurray JJV, Claggett B, et al; DELIVER Trial Committees and Investigators. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-98.?