Dapagliflozin consistently and safely reduced clinical events in patients with HFmrEF or HFpEF, irrespective of background beta-blocker use, which was not associated with worse outcomes.
RCT (n=6,263)
randomized
Yes
Does dapagliflozin reduce cardiovascular death or worsening heart failure in patients with HFmrEF or HFpEF irrespective of background beta-blocker use, and is beta-blocker use associated with adverse outcomes?
In patients with HFmrEF or HFpEF, background beta-blocker use is highly prevalent and does not attenuate the clinical benefits of dapagliflozin nor increase the risk of adverse cardiovascular events.
p-value: p=0.85
BACKGROUND: Although beta-blockers are not recommended for the treatment of heart failure with preserved ejection fraction (HFpEF) according to the latest European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, these therapies remain commonly used for comorbidity management. There has been concern that beta-blockers may adversely influence clinical outcomes by limiting chronotropic response in HFpEF. OBJECTIVES: This study sought to examine the contemporary use and implications of beta-blockers in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF. METHODS: In the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, a total of 6,263 patients with symptomatic heart failure (HF) with a left ventricular ejection fraction (LVEF) >40% were randomized to dapagliflozin or placebo across 20 countries. In this prespecified analysis, efficacy and safety outcomes were examined according to beta-blocker use at randomization. The primary outcome was cardiovascular death or worsening HF. RESULTS: = 0.85), with similar findings for key secondary endpoints. Adverse events were balanced between patients randomized to dapagliflozin and placebo, regardless of background beta-blocker use. CONCLUSIONS: In patients with HFmrEF or HFpEF who were enrolled in DELIVER, 4 out of 5 participants were treated with a beta-blocker. Beta-blocker use was not associated with a higher risk of worsening HF or cardiovascular death. Dapagliflozin consistently and safely reduced clinical events, irrespective of background beta-blocker use. (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure DELIVER; NCT03619213).
Peikert et al. (Wed,) conducted a rct in Heart failure with mildly reduced or preserved ejection fraction (HFmrEF or HFpEF) (n=6,263). Dapagliflozin (stratified by beta-blocker use) vs. Placebo was evaluated on Cardiovascular death or worsening HF (p=0.85). Dapagliflozin consistently and safely reduced clinical events in patients with HFmrEF or HFpEF, irrespective of background beta-blocker use, which was not associated with worse outcomes.