Effects of dapagliflozin in heart failure with reduced ejection fraction, and chronic obstructive pulmonary disease: an analysis of DAPA-HF

Pooja Dewan, Kieran F Docherty, Olof Bengtsson, Rudolf A de Boer, Akshay S Desai, Jaroslaw Drozdz, Nathaniel M Hawkins, Silvio E Inzucchi, Masafumi Kitakaze, Lars Køber, Mikail N Kosiborod, Anna M Langkilde, Daniel Lindholm, Felipe A Martinez, Béla Merkely, Mark C Petrie, Piotr Ponikowski, Marc S Sabatine, Morten Schou, Mikaela SjöstrandScott D Solomon, Subodh Verma, Pardeep S Jhund, John Jv McMurray*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

AIMS: Chronic obstructive pulmonary disease (COPD) is an important comorbidity in HFrEF, associated with worse outcomes and often suboptimal treatment because of under-prescription of beta-blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. To examine outcomes related to COPD in a post hoc analysis of the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF).

METHODS & RESULTS: We examined whether the effects of dapagliflozin in DAPA-HF were modified by COPD status. The primary outcome was the composite of an episode of worsening heart failure (HF) event or cardiovascular (CV) death. 585 (12.3%) of the 4744 patients randomized had a history of COPD. Patients with COPD were more likely to be older men with a history of smoking, worse renal function, and higher baseline NT-proBNP, and less likely to be treated with a beta-blocker or mineralocorticoid receptor antagonist. The incidence of the primary outcome was higher in patients with COPD than in those without 18.9 (95% CI 16.0-22.2) versus 13.0 (12.1-14.0) per 100 person-years; hazard ratio (HR) for COPD versus no COPD 1.44 (1.21-1.72), P<0.001. The effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with (HR 0.67 [95%CI 0.48-0.93]) and without COPD (0.76 [0.65-0.87]); interaction p-value 0.47.

CONCLUSIONS: In DAPA-HF, one-in-eight patients with HFrEF had concomitant COPD. Participants with COPD had a higher risk of the primary outcome. The benefit of dapagliflozin on all prespecified outcomes was consistent in patients with and without COPD.

Original languageEnglish
Article numberejhf.2083
Number of pages13
JournalEuropean Journal of Heart Failure
Early online date23-Dec-2020
DOIs
Publication statusPublished - 18-Jan-2021

Keywords

  • Heart failure
  • Dapagliflozin
  • Chronic obstructive pulmonary disease

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