In hospitalized patients with acute heart failure, dapagliflozin missed its primary endpoint but showed benefits in diuretic use and time to discharge.
Dapagliflozin on top of high-dose intravenous loop diuretics just missed its primary endpoint of improving diuretic efficiency in hospitalized patients with acute heart failure (HF). Nonetheless, the data of DICTATE-AHF support the early initiation of dapagliflozin to facilitate decongestion and guideline-directed medical therapy optimization in acute HF, according to the authors.
“Loop diuretics plus SGLT2 inhibitors have consistently displayed to improve outcomes in patients with HF,” said Zachary Cox, PharmD, at ESC Congress 2023. “However, the safety and efficacy of early, in-hospital initiation of dapagliflozin has not yet been demonstrated.” The phase 3 DICTATE-AHF trial randomly assigned 240 patients with acute HF, within 24 hours after admission to hospital, 1:1 to dapagliflozin 10 mg daily plus structured usual care with protocolized diuretic titration or usual care only. The primary outcome was diuretic efficiency until day 5 or until hospital discharge, calculated by the cumulative weight change divided by cumulative loop diuretic dose and expressed as kg/40 mg intravenous furosemide equivalents.
Dapagliflozin just missed the primary endpoint with an OR of 0.65 (95% CI, 0.41–1.01; P=0.06) compared with usual care. Dr. Cox clarified that the cumulative weight change was identical for both arms, but that the median dose of cumulative loop diuretics was significantly lower in the dapagliflozin arm (560 mg vs 800 mg; P=0.006). Furthermore, 52% of the participants in the dapagliflozin arm had discontinued intravenous diuretics at day 5 compared with 33% of those in the usual-care arm (P=0.006). Equal rates were observed for time to discharge, showing that participants taking dapagliflozin had a shorter time to discharge (P=0.007). Finally, there were no differences between both arms regarding safety outcomes, such as worsening HF, readmission for acute decompensated HF, hypoglycemia, genitourinary tract infections, ketoacidosis, or diabetes-related readmissions.
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