Dapagliflozin improves outcomes for elderly TAVR patients with heart failure
Giving dapagliflozin to elderly heart failure patients who undergo transcatheter aortic valve replacement (TAVR) is associated with significant benefits, according to a late-breaking clinical trial presented at ACC.25, the annual conference of the American College of Cardiology.
Sergio Raposeiras-Roubin, MD, a clinical cardiologist at Álvaro Cunqueiro Hospital in Vigo, Spain, presented the data, noting that questions remain about the use of SGLT-2 inhibitors among TAVR patients and among very elderly patients. To learn more, he and his team evaluated from more than 1,200 TAVR patients treated in Spain with a mean age of 82.4 years old. Nearly 50% of patients were women. All patients presented with a history of diabetes, poor kidney function or another known complication associated with poor outcomes. Patients were randomized to either take daily dapagliflozin or a placebo for one year.
Overall, dapagliflozin was associated with a 28% reduction in the study’s primary endpoint, a composite of all-cause mortality and worsening heart failure symptoms. Patients given the drug also experienced a 37% reduction in worsening heart failure compared to patients given a placebo. These benefits remained in place regardless of the patient’s sex, age, kidney function or diabetes status.
“Previous trials have provided evidence for SGLT-2 inhibitors in patients with a variety of other conditions but have excluded patients with valvular heart disease,” Raposeiras-Roubin explained. “Based on our study, if you have a patient undergoing TAVI who is at risk of heart failure, it is important to treat them with dapagliflozin or another SGLT-2 inhibitor. These are safe drugs and have a lot of benefit.”
Raposeiras-Roubin did note that taking dapagliflozin was linked to an increased risk of hypotension and genital infection. Urinary tract infections were also seen in these patients, but they were also seen at a relatively high rate among patients in the placebo group.
These findings were simultaneously published in The New England Journal of Medicine.[1] Click here to read the full analysis.
Data could immediately impact patient care
Interventional cardiologist Deepak L. Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, was a panelist at ACC.25 when these findings were presented to the audience. Bhatt congratulated Raposeiras-Roubin on the research and said these results will make an immediate impact on the way he treats this patient population.
“For me, this will be practice-changing when I go back to New York,” Bhatt said. “I think I’m pretty good with my heart failure patients and making sure that those without contraindications are discharged on an SGLT-2 inhibitor. But I must say, with my TAVR patients, that is not part of the checklist. So I do think these results are immediately practice-changing for patients who would have met the eligibility criteria for the DapaTAVI trial.”
A funny moment to remember
Raposeiras-Roubin closed his speech in an unexpected way, playing a “DapaTAVI” song that had the audience laughing, dancing and clapping along. He grinned from ear to ear as everyone enjoyed the song, and Bhatt even commented on it from the ACC.25 stage.
“I’ve been involved with a lot of trials and discussed a lot of trials, but that is the first time I’ve ever heard a trial song” Bhatt said, smiling. “I’m not sure if I’m obligated to get up here and do a DapaTAVI dance. If I had more time, I would.”
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.