British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
JACC Heart Fail. 2024 Sep;12(9):1586-1599. doi: 10.1016/j.jchf.2024.01.018. Epub 2024 Apr 3.
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]; P = 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.
最近因心力衰竭（HF）住院的患者发生不良临床结局的风险较高，但与被认为更“稳定”的患者相比，他们可能从有效的治疗中获得更大的绝对和相对获益。
作者通过 DAPA-HF（达格列净预防心力衰竭恶化）和 DELIVER（达格列净评估改善射血分数保留心力衰竭患者的生活）的患者水平汇总分析，根据心力衰竭住院的时间，研究达格列净的作用。
共有 11007 例患者在 DAPA-HF 和 DELIVER 中被随机分组。主要终点是心力衰竭恶化或心血管死亡的复合终点。
共有 12.4%的患者在随机分组后 3 个月内因 HF 住院，14.2%的患者在 3 至 12 个月之间住院，16.8%的患者在随机分组前 1 年以上住院，而 56.5%的患者没有住院。主要终点的风险与既往 HF 住院时间呈反比，近期 HF 住院患者的风险最高。与安慰剂相比，达格列净降低了心力衰竭住院类别中主要结局的风险（0-3 个月，HR：0.66 [95%CI：0.55-0.81]；3-12 个月，HR：0.73 [95%CI：0.59-0.90]；＞1 年，HR：0.91 [95%CI：0.74-1.12]；没有既往住院史，HR：0.83 [95%CI：0.73-0.94]；P=0.09）。在中位随访 22 个月期间，达格列净预防 1 例事件所需的治疗人数分别为 13、20、23 和 28。无论心力衰竭住院类别如何，LVEF 范围内的疗效均一致。
达格列净的相对获益在 LVEF 范围内是一致的，无论最近一次心力衰竭住院的时间如何，最近住院的患者绝对获益更大。
