Early Initiation of Dapagliflozin during Hospitalization for Acute Heart Failure Is Associated with a Shorter Hospital Stay

Q: What are the key findings of this study?

Early initiation of dapagliflozin (≤6 days) during hospitalization for acute heart failure was associated with a significantly shorter median hospital stay compared to late initiation.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute Heart Failure (n=118). Intervention: Early initiation of dapagliflozin (≤6 days after admission) vs. Late initiation of dapagliflozin (≥7 days after admission). Primary outcome: Length of hospital stay (median days) (p=0.002).

Saki Mizobuchi; Yuki Saito; Masatsugu Miyagawa; Yutaka Koyama; Hidesato Fujito; Keisuke Kojima; Korehito Iida; Nobuhiro Murata; Akimasa Yamada; Daisuke Kitano; Kazuto Toyama; Daisuke Fukamachi; Yasuo Okumura

doi:10.2169/internalmedicine.1215-22

March 14, 2023Internal MedicineOpen Access

Early Initiation of Dapagliflozin during Hospitalization for Acute Heart Failure Is Associated with a Shorter Hospital Stay

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Key result

Early dapagliflozin in AHF linked to ~6 fewer hospital days versus late initiation.

P=0.002
n=118

Figures

Why the study?

The clinical significance of the timing of starting dapagliflozin after hospital admission for acute heart failure remains unclear.

Does early initiation of dapagliflozin reduce length of hospital stay in patients with acute heart failure?

Study Design

Type

Observational (n=118)

Multicenter

No

Structured PICO

Does early initiation of dapagliflozin reduce length of hospital stay in patients with acute heart failure?

P

Population

118 patients with acute heart failure (AHF) admitted to a single center in Japan, who were continuously treated with dapagliflozin (10 mg once daily) after hospital admission.

I

Intervention

Early initiation of dapagliflozin (10 mg/day oral) within 6 days of hospital admission.

C

Comparator

Late initiation of dapagliflozin (10 mg/day oral) on day 7 or later after hospital admission.

O

Outcome

Length of hospital stay

Main Result

Absolute Event Rate: 16.5% vs 22%

p-value: p=0.002

Early initiation of dapagliflozin within 6 days of admission for acute heart failure is independently associated with a significantly shorter hospital stay.

Limitations

Single-center study with a relatively small sample size
Potential confounding by congestion severity at admission, as estimated plasma volume status was higher in the late initiation group
Dapagliflozin use in HFpEF was limited to patients with type 2 diabetes or chronic kidney disease due to insurance indications in Japan
Small sample size limits concrete conclusions regarding different types of heart failure (de novo vs. worsening)
Exclusion of patients transferred to other hospitals may have introduced selection bias
Only investigated dapagliflozin, so results may not generalize to other SGLT2 inhibitors

Implication

Does not support changing dapagliflozin timing yet; hypothesis-generating and requires RCT confirmation.

Abstract

Objective Sodium-glucose co-transporter-2 inhibitors (SGLT2is), such as dapagliflozin, have a diuretic effect, and their early initiation to treat acute heart failure (AHF) may improve outcomes; however, the significance of the timing of starting dapagliflozin after hospital admission remains unclear. Methods We performed a post hoc analysis of a prospective, observational registry. Participants were divided into the early (E) group and late (L) group using the median time to the initiation of dapagliflozin (6 days) as the cut-off. We evaluated the relationship between the time to the initiation of dapagliflozin after hospital admission and patient characteristics and the length of the hospital stay. Patients Study subjects were 118 patients with AHF admitted between January 2021 and April 2022 who were started on dapagliflozin treatment (10 mg/day). Results Patients were divided into the E group (n=63) and L group (n=55). The HF severity as evaluated by the New York Heart Association class and the N-terminal pro-brain natriuretic peptide level was not significantly different between the groups. The time to the initiation of dapagliflozin and length of hospital stay showed a significant positive correlation (p<0.001, r=0.46). The hospital stay was significantly shorter in group E [median, 16.5 days; interquartile range (IQR): 13-22 days] than in group L (median, 22 days; IQR: 17-27 days; p=0.002). A multivariate logistic regression analysis showed that the early initiation of dapagliflozin was independently associated with a shorter hospital stay, even after multiple adjustments. Conclusion Early initiation of dapagliflozin after hospital admission is associated with a shorter hospital stay, suggesting it is a key factor for shortening hospital stays.

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Cite This Study

Mizobuchi et al. (2023) conducted an observational in Acute Heart Failure (n=118). Early initiation of dapagliflozin (≤6 days after admission) vs. Late initiation of dapagliflozin (≥7 days after admission) was evaluated on Length of hospital stay (median days) (p=0.002). Early initiation of dapagliflozin (≤6 days) during hospitalization for acute heart failure was associated with a significantly shorter median hospital stay compared to late initiation.

synapsesocial.com/papers/6a082498df3db87398107ddd https://doi.org/10.2169/internalmedicine.1215-22