多药
达帕格列嗪
射血分数
医学
心力衰竭
内科学
安慰剂
共病
相伴的
不利影响
心脏病学
重症监护医学
糖尿病
内分泌学
替代医学
2型糖尿病
病理
作者
Alexander Peikert,Parag Goyal,Muthiah Vaduganathan,Brian Claggett,Ian J. Kulac,Zi Michael Miao,Orly Vardeny,Mikhail Kosiborod,Akshay S. Desai,Pardeep S. Jhund,Carolyn S.P. Lam,Silvio E. Inzucchi,Felipe A. Martínez,Rudolf A. de Boer,Adrian F. Hernandez,Sanjiv J. Shah,Magnus Petersson,Anna Maria Langkilde,John J.V. McMurray,Scott D. Solomon
标识
DOI:10.1016/j.jchf.2023.05.014
摘要
Patients with heart failure (HF) have a high burden of multimorbidity, often necessitating numerous medications. There may be clinical concern about introducing another medication, especially among individuals with polypharmacy. This study examined the efficacy and safety of addition of dapagliflozin according to the number of concomitant medications in HF with mildly reduced or preserved ejection fraction. In this post hoc analysis of the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, 6,263 participants with symptomatic HF with left ventricular ejection fraction >40% were randomized to dapagliflozin or placebo. Baseline medication use (including vitamins and supplements) was collected. Efficacy and safety outcomes were assessed by medication use categories (“nonpolypharmacy”: <5 medications; “polypharmacy”: 5 to 9 medications; and “hyperpolypharmacy”: ≥10 medications) and continuously. The primary outcome was worsening HF or cardiovascular death. Overall, 3,795 (60.6%) patients met polypharmacy and 1,886 (30.1%) met hyperpolypharmacy criteria. Higher numbers of medications were strongly associated with higher comorbidity burden and increased rates of the primary outcome. Compared with placebo, dapagliflozin similarly reduced the risk of the primary outcome irrespective of polypharmacy status (nonpolypharmacy HR: 0.88 [95% CI: 0.58-1.34]; polypharmacy HR: 0.88 [95% CI: 0.75-1.03]; hyperpolypharmacy HR: 0.73 [95% CI: 0.60-0.88]; Pinteraction = 0.30). Similarly, benefits with dapagliflozin were consistent across the spectrum of total medication use (Pinteraction = 0.06). Although adverse events increased with higher number of medications, they were not more frequent with dapagliflozin, regardless of polypharmacy status. In the DELIVER trial, dapagliflozin safely reduced worsening HF or cardiovascular death across a broad range of baseline medication use, including among individuals with polypharmacy (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213)
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