Dapagliflozin improves symptoms in some, but not all, heart failure patients
Treatment with dapagliflozin is associated with improved symptoms in patients with heart failure with reduced ejection fraction (HFrEF), but not patients with heart failure with preserved ejection fraction (HFpEF), according to new findings published in Circulation.[1]
The popular SGLT2 inhibitor, sold by AstraZeneca under the brand name Farxiga, is already known to reduce the risk of cardiovascular death and heart failure hospitalization in patients with HFrEF and HFpEF. In fact, it is approved by the U.S. Food and Drug Administration to treat all heart failure patients as well as patients with type 2 diabetes and chronic kidney disease.
However, data on its ability to affect symptoms in those patients have been inconsistent over the years. To take a closer look at this issue, lead author John J.V. McMurray, MD, a cardiologist with the University of Glasgow, and colleagues examined data from more than 300 HFrEF patients and more than 500 HFpEF patients. Patients were randomized to either receive dapagliflozin or a placebo for 16 weeks.
McMurray et al. tracked how dapagliflozin impacted each patient’s Kansas City Cardiomyopathy Questionnaire (KCCQ) Total Symptom Score (TSS) and Physical Limitation Scale (PLS). Another key focus was whether or not treatment impacted each patient’s six-minute walk distance (6MWD).
“Few trials have reported the effect of any treatment on KCCQ-PLS as opposed to KCCQ-TSS,” the authors wrote. “KCCQ-PLS quantifies how limited patients feel when undertaking routine activities (eg, dressing, showering, walking, doing housework).”
Overall, dapagliflozin was linked to improvements in KCCQ-TSS and “a borderline effect” on KCCQ-PLS among patients with HFrEF. It did have an effect on 6MWD. Among patients with HFpEF, however, dapagliflozin was not associated with improvements in KCCQ-TSS, KCCQ-PLS or 6MWD.
These findings appear to confirm that dapagliflozin is an effective way to improve the patient-reported burden of heart failure symptoms in certain patients. However, researchers were unsure what to make of the 6MWD data.
“The neutral effect of dapagliflozin on 6MWD, along with the results of additional trials with SGLT inhibitors and other heart failure treatments showing no benefit on 6MWD despite beneficial effects on patient-reported outcomes, raises questions as to its value as a measure of functional capacity in heart failure,” the group wrote.
AstraZeneca did fund this analysis. In addition, McMurray’s work was supported by a grant from the British Heart Foundation Center of Research Excellence.
Click here to read the full study.
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.