New treatment significantly lowers the risk of cardiovascular death in patients with heart failure

A medication, commonly used for the treatment of type 2 diabetes, has been found to significantly lower the risk of cardiovascular death in patients with heart failure. A team of international researchers also found that the same drug was able to reduce worsening heart failure.

Two linked studies, published in the New England Journal of Medicine and Nature Medicine, and delivered at the European Society of Cardiology (ESC) Congress 2022 in Barcelona, looked at the benefits of prescribing the drug dapagliflozin (Farxiga) to patients with heart failure.

The Phase III DELIVER trial, which was co-led by Brigham and Women’s Hospital, Boston/Harvard Medical School and the University of Glasgow, and funded by AstraZeneca, published its results in the New England Journal of Medicine. Researchers for this study assessed heart failure patients with or without type-2 diabetes and found that prescribing dapagliflozin significantly reduced cardiovascular death or worsening heart failure in patients with heart failure by 18%, when compared to a placebo.

The second paper, published in Nature Medicine, looked at data from the DELIVER trial alongside data from the 2019 University of Glasgow-led Phase III DAPA-HF trial, which looked at the impact of prescribing dapagliflozin to patients with another type of heart failure. This study also found that dapagliflozin significantly reduced cardiovascular death in patients with heart failure. Together, these trials show that all patients with the two major types of heart failure benefit substantially from dapagliflozin.

Heart failure is a chronic, long-term condition that worsens over time. It affects nearly 64 million people globally and is associated with both substantial morbidity and mortality. Chronic heart failure is the leading cause of hospitalisation for those over the age of 65, and represents a significant clinical and economic burden.

Professor John McMurray, Professor of Medical Cardiology at the University of Glasgow, said: "In this patient-level meta-analysis including over 11,000 patients with heart failure across the full range of ejection fraction, dapagliflozin reduced the risk of both cardiovascular death and heart failure hospitalisation. These results underpin the valuable role dapagliflozin can play in clinical practice, as we can initiate treatment right away while waiting for ejection fraction to be measured."

The Nature Medicine study showed that, overall, dapagliflozin reduced the risk of cardiovascular death by 14% over the median follow-up of 22 months, and death from any cause by 10%. The medication also reduced the total number (first and repeat) of hospitalisations for heart failure by 29%.

Dr. Scott Solomon, Professor of Medicine at Harvard Medical School and Brigham and Women’s Hospital, said: "These results from DELIVER are important for patients and clinical care as it shows that dapagliflozin is effective regardless of ejection fraction and therefore can be used as foundational therapy in all eligible patients with heart failure. Earlier heart failure with preserved ejection fraction trials have shown attenuation in the highest left ventricular ejection fraction but with dapagliflozin results are consistent across the ejection fraction range. The findings also reinforce most recent treatment guidelines, recommending earlier initiation of guideline-directed medical treatment and may support broader use of SGLT2 inhibitors in clinical practice."

Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca, said: "Heart failure patients with left ventricular ejection fraction greater than 40% are the most difficult to treat with few treatment options available to them. We are proud to share the groundbreaking DELIVER results, which have expanded our understanding of the complexities of HF. These data build upon our previous studies demonstrating cardiorenal protection of Farxiga across patients with type-2 diabetes, chronic kidney disease and heart failure."