Dapagliflozin for Heart Failure with Preserved Ejection Fraction: Will the DELIVER Study Deliver?
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REVIEW
Dapagliflozin for Heart Failure with Preserved Ejection Fraction: Will the DELIVER Study Deliver? David M. Williams
. Marc Evans
Received: July 25, 2020 Ó The Author(s) 2020
ABSTRACT Drug therapies for people with heart failure and preserved ejection fraction (HFpEF) are often limited to diuretics to improve symptoms as no therapies demonstrate a mortality benefit in this cohort. People with diabetes have a high risk of developing HFpEF and vice versa, suggesting shared pathophysiological mechanisms exist, which in turn engenders the potential for shared treatments. Dapagliflozin is a sodium–glucose co-transporter 2 (SGLT2) inhibitor which has demonstrated significantly improved cardiovascular and hospitalisation for heart failure (HHF) outcomes in previous cardiovascular outcome trials (CVOTs). These CVOTs include the DECLARE-TIMI and DAPA-
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12799982. D. M. Williams (&) M. Evans Department of Diabetes and Endocrinology, University Hospital Llandough, Cardiff, UK e-mail: [email protected]
HF studies which observed significant benefits for people with heart failure and specifically those with heart failure and reduced ejection fraction (HFrEF), respectively. The ongoing DELIVER study is evaluating the use of dapagliflozin specifically in people with HFpEF, which may have enormous implications for treatment and considerable economic consequences. This will complement previous and other ongoing CVOTs evaluating dapagliflozin use. In this review we discuss the use of SGLT2 inhibitors in HFrEF and HFpEF with a focus on the DELIVER study and its potential health and economic implications.
Keywords: Dapagliflozin; DELIVER study; Heart failure; Preserved ejection fraction; SGLT2 inhibitors; Type 2 diabetes
Diabetes Ther
Key Summary Points Dapagliflozin improved cardiovascular and hospitalization for heart failure (HHF) outcomes in people with heart failure and reduced ejection fraction (HFrEF) in the DAPA-HF study. However, it remains unknown whether drug therapy including dapagliflozin or any sodium–glucose co-transporter 2 (SGLT2) inhibitor improves cardiovascular or HHF outcomes in people with heart failure and preserved ejection fraction (HFpEF). The DELIVER study aims to determine the impact of dapagliflozin on cardiovascular death, HHF or urgent heart failure visit in people with HFpEF. Treatments which reduce the rate of HHF may have the greatest economic impact since hospitalization accounts for the majority of heart failure treatment costs.
INTRODUCTION Heart failure is an increasingly recognised diagnosis in people with diabetes and its prevalence is increasing, with an estimated 26 million people diagnosed worldwide and an estimated global economic burden of over US$108 billion [1, 2]. Whilst the economic impact of heart failure is substantial, the personal impact including recurrent hospitalisation and poorer quality of life outcomes compared with most chronic diseases is significa
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