Clinical Outcomes of Dapagliflozin in Heart Failure With Reduced Ejection Fraction: A Comprehensive Review

Heart failure with reduced ejection fraction (HFrEF) remains an important health challenge worldwide, especially in Asia and India where there is a younger patient population, along with a high prevalence of type 2 diabetes, hypertension, and chronic kidney disease. Despite advances in the standard management of heart failure, considerable residual risk of hospitalization and death exists. This review highlights the clinical significance of dapagliflozin and includes data from the DECLARE-TIMI 58 trial and its subgroup analyses with more than 17,000 patients having type 2 diabetes. Dapagliflozin (10 mg per day) decreased the rate of cardiovascular mortality or hospitalization due to HF by 17% and the rate of heart failure hospitalization by 27%. These effects were independent of sub-group analysis, including in patients with HFrEF, with no impact on the eGFR decline and adverse effects primarily limited to genital infections. Also, real-life data and economic analysis provide additional evidence to consider this drug. Nowadays, international and Indian guidelines recommend dapagliflozin as one of the mainstays of the therapy in patients with HFrEF along with other GDMT. In conclusion, dapagliflozin offers a safe, effective strategy to improve outcomes in HFrEF, particularly in resource limited settings. Early and wider adoption could significantly decrease the burden of heart failure.