Atrial Fibrillation and Dapagliflozin Efficacy in Patients With Preserved or Mildly Reduced Ejection Fraction

Jawad H. Butt, Toru Kondo, Pardeep S. Jhund, Josep Comin-Colet, Rudolf A. de Boer, Akshai S. Desai, Adrian F. Hernandez, Silvio E. Inzucchi, Stefan P. Janssens, Mikhail N. Kosiborod, Carolyn S.P. Lam, Anna Maria Langkilde, Daniel Lindholm, Felipe Martinez, Magnus Petersson, Sanjiv J. Shah, Jorge Thierer, Muthiah Vaduganathan, Subodh Verma, Ulrica WilderängBrian C. Claggett, Scott D. Solomon, John J.V. McMurray*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Atrial fibrillation (AF) is common in heart failure (HF), is associated with worse outcomes compared with sinus rhythm, and may modify the effects of therapy. Objectives: This study examined the effects of dapagliflozin according to the presence or not of AF in the DELIVER (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure) trial. Methods: A total of 6,263 patients with HF with New York Heart Association functional class II-IV, left ventricular ejection fraction >40%, evidence of structural heart disease, and elevated N-terminal pro–B-type natriuretic peptide levels were randomized to dapagliflozin or placebo. Clinical outcomes and the effect of dapagliflozin, according to AF status, were examined. The primary outcome was a composite of cardiovascular death or worsening HF. Results: Of the 6,261 patients with data on baseline AF, 43.3% had no AF, 18.0% had paroxysmal AF, and 38.7% had persistent/permanent AF. The risk of the primary endpoint was higher in patients with AF, especially paroxysmal AF, driven by a higher rate of HF hospitalization: no AF, HF hospitalization rate per 100 person-years (4.5 [95% CI: 4.0-5.1]), paroxysmal AF (7.5 [95% CI: 6.4-8.7]), and persistent/permanent AF (6.4 [95% CI: 5.7-7.1]) (P < 0.001). The benefit of dapagliflozin on the primary outcome was consistent across AF types: no AF, HR: 0.89 (95% CI: 0.74-1.08); paroxysmal AF, HR: 0.75 (95% CI: 0.58-0.97); persistent/permanent AF, HR: 0.79 (95% CI: 0.66-0.95) (Pinteraction = 0.49). Consistent effects were observed for HF hospitalization, cardiovascular death, all-cause mortality, and improvement in the KCCQ-TSS. Conclusions: In DELIVER, the beneficial effects of dapagliflozin compared with placebo on clinical events and symptoms were consistent, irrespective of type of AF at baseline. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure.

Original languageEnglish (US)
Pages (from-to)1705-1717
Number of pages13
JournalJournal of the American College of Cardiology
Volume80
Issue number18
DOIs
StatePublished - Nov 1 2022

Keywords

  • atrial fibrillation
  • clinical trial
  • heart failure
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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