Efficacy and Safety of Dapagliflozin in Patients With Acute Heart Failure

达帕格列嗪 利尿剂 医学 利尿剂 心力衰竭 内科学 泌尿科 糖尿病 2型糖尿病 内分泌学
作者
Zachary L. Cox,Sean P. Collins,Gabriel A. Hernandez,A. Thomas McRae,Beth Towery Davidson,Kirkwood F. Adams,Mark F. Aaron,Luke Cunningham,Cathy A. Jenkins,Christopher J. Lindsell,Frank E. Harrell,Christina Kampe,Karen F. Miller,William B. Stubblefield,JoAnn Lindenfeld
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:83 (14): 1295-1306 被引量:33
标识
DOI:10.1016/j.jacc.2024.02.009
摘要

The primary goals during acute heart failure (AHF) hospitalization are decongestion and guideline-directed medical therapy (GDMT) optimization. Unlike diuretics or other GDMT, early dapagliflozin initiation could achieve both AHF goals. The authors aimed to assess the diuretic efficacy and safety of early dapagliflozin initiation in AHF. In a multicenter, open-label study, 240 patients were randomized within 24 hours of hospital presentation for hypervolemic AHF to dapagliflozin 10 mg once daily or structured usual care with protocolized diuretic titration until day 5 or hospital discharge. The primary outcome, diuretic efficiency expressed as cumulative weight change per cumulative loop diuretic dose, was compared across treatment assignment using a proportional odds model adjusted for baseline weight. Secondary and safety outcomes were adjudicated by a blinded committee. For diuretic efficiency, there was no difference between dapagliflozin and usual care (OR: 0.65; 95% CI: 0.41-1.02; P = 0.06). Dapagliflozin was associated with reduced loop diuretic doses (560 mg [Q1-Q3: 260-1,150 mg] vs 800 mg [Q1-Q3: 380-1,715 mg]; P = 0.006) and fewer intravenous diuretic up-titrations (P ≤ 0.05) to achieve equivalent weight loss as usual care. Early dapagliflozin initiation did not increase diabetic, renal, or cardiovascular safety events. Dapagliflozin was associated with improved median 24-hour natriuresis (P = 0.03) and urine output (P = 0.005), expediting hospital discharge over the study period. Early dapagliflozin during AHF hospitalization is safe and fulfills a component of GDMT optimization. Dapagliflozin was not associated with a statistically significant reduction in weight-based diuretic efficiency but was associated with evidence for enhanced diuresis among patients with AHF. (Efficacy and Safety of Dapagliflozin in Acute Heart Failure [DICTATE-AHF]; NCT04298229)
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