达帕格列嗪
医学
心力衰竭
临床终点
安慰剂
内科学
射血分数
不利影响
随机化
随机对照试验
相对风险
心脏病学
置信区间
糖尿病
内分泌学
替代医学
病理
2型糖尿病
作者
Jawad H. Butt,Pardeep S. Jhund,Kieran F. Docherty,Brian Claggett,Muthiah Vaduganathan,Erasmus Bachus,Adrian F. Hernandez,Carolyn S.P. Lam,Silvio E. Inzucchi,Felipe A. Martínez,Rudolf A. de Boer,Mikhail Kosiborod,Akshay S. Desai,Lars Køber,Piotr Ponikowski,Marc S. Sabatine,Scott D. Solomon,John J.V. McMurray
标识
DOI:10.1016/j.jchf.2024.01.018
摘要
Patients recently hospitalized for heart failure (HF) are at a higher risk of adverse clinical outcomes, but they may experience a greater absolute and relative benefit from effective therapies than individuals who are considered more "stable." The authors examined the effects of dapagliflozin according to the timing of prior HF hospitalization in a patient-level pooled analysis of DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) and DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure). A total of 11,007 patients were randomized in DAPA-HF and DELIVER. The primary outcome was the composite of worsening HF or cardiovascular death. In total, 12.4% were hospitalized for HF within 3 months of randomization, 14.2% between 3 and 12 months, and 16.8% more than 1 year before randomization, whereas 56.5% had not been hospitalized. The risk of the primary endpoint was inversely associated with time from prior HF hospitalization, and patients with a recent HF hospitalization had the highest risk. Compared with placebo, dapagliflozin reduced the risk of the primary outcome across HF hospitalization category (0-3 months, HR: 0.66 [95% CI: 0.55-0.81]; 3-12 months, HR: 0.73 [95% CI: 0.59-0.90]; >1 year, HR: 0.91 [95% CI: 0.74-1.12]; and no prior hospitalization, HR: 0.83 [95% CI: 0.73-0.94]; Pinteraction = 0.09). The number of patients needed to treat with dapagliflozin to prevent 1 event over the median follow-up of 22 months was 13, 20, 23, and 28, respectively. The beneficial effect was consistent across the range of LVEF regardless of HF hospitalization category. The relative benefits of dapagliflozin were consistent across the range of LVEF regardless of the timing of the most recent HF hospitalization with a greater absolute benefit in patients with recent hospitalization.
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