Dapagliflozin still beneficial for HFpEF, HFmrEF patients with AFib
Dapagliflozin (Farxiga) is associated with consistent benefits for patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) who also have baseline atrial fibrillation (AFib), according to a new analysis published in the Journal of the American College of Cardiology.[1]
“The identification of effective therapies for patients with both HFpEF and AFib is very important,” wrote first author Jaward Haider Butt, MD, a specialist with the University of Glasgow, and colleagues. “However, not all treatments for heart failure are effective in patients with concomitant AFib.”
Butt et al. examined data from more than 6,000 patients. All data came from the previously completed DELIVER trial, which explored the potential impact of treatment with dapagliflozin on a variety of patients with HFpEF.
While 43.3% of patients had no AFib, 38.7% had persistent AFib and 18% had paroxysmal AFib. The study’s primary outcome, a composite of cardiovascular mortality or worsening heart failure symptoms, was much higher among patients with AFib, especially those with paroxysmal AFib.
The authors emphasized that dapagliflozin, compared with a placebo, was associated with consistently reducing the risk of the primary outcome in both patients with AFib and without AFib. The group identified “no interaction between AFib status and effect of treatment,” a trend that continued when evaluating secondary clinical outcomes such as repeat heart failure hospitalizations and all-cause mortality.
The team did note that there were certain limitations to its findings. For example, the DELIVER trial’s exclusion criteria likely left some certain high-risk patients from taking part in the analysis; this could have potentially impacted the generalizability of the analysis. Also, “paroxysmal AFib may have been undiagnosed in some patients.”
Even with those limitations in mind, however, this subanalysis of the DELIVER trial highlights the significant impact dapagliflozin—which is sold under the name Farxiga—can have on heart failure patients.
“In DELIVER, the beneficial effects of dapagliflozin, compared with placebo, on clinical events and symptoms were not modified by AFib at baseline, irrespective of definition or type of AFib,” the authors concluded. “These findings provide further evidence for dapagliflozin as a new treatment option for patients with HFmrEF/HFpEF.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.