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Dapaglifozin in the real world – What is the impact on heart failure with reduced ejection fraction already under optimized therapy?
Session:
Posters (Sessão 6 - Écran 4) - Insuficiência Cardíaca 6 - Inibidores SGLT1
Speaker:
Joana Silvério Simões
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joana Silvério Simões; Tatiana Duarte; Sara Gonçalves; Ana Sousa; Crisálida Ferreira; Marta Ferreira; Joana Ferreira; Rui Caria; Ermelinda Pedroso
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Heart failure with reduced ejection fraction (HFrEF) has a high worldwide prevalence and considerable morbidity and mortality, even under optimized therapy. Dapaglifozin, one of the lastet drugs approved for its therapy, was associated with a significative reduction of cardiovascular death and hospitalization for HF (DAPA-HF trial).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objective: To evaluate the real-world impact of the introduction of dapaglifozin in patients (pts) with HFrEF already under optimized therapy.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: A retrospective cohort study was conducted, including pts followed for HF in a district hospital, with LVEF≤40% under optimized therapy that received dapaglifozin. The outcomes evaluated were NYHA functional class, renal clearance, NT-proBNP, LVEF, adverse events, hospitalization for decompensated HF and mortality during the 1-year follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: In a sample of 73 pts (72.6% male; mean age 66.3±12.1 years; 68.5% in NYHA II), 79.5% were treated with neprisilin inhibitor, 95.9% with beta-blocker and 82.2% with mineralocorticoid receptor antagonists. One month after starting dapaglifozin, there was no statistically significant reduction in NT-proBNP (1516 (IQR4348.0) vs 1326.5 (IQR 3858.0) pg/mL, p=0.506), with 32.9% (n=24) with a reduction >15% in this parameter. NYHA class has improved ou sustained in 82.3% patients (<em>p</em>=0.072). There was a slight improvement in ejection fraction (26.0(IQR 15.8) vs 27.5(IQR20.3)%, p=0.456), however without statistically significance. Only 5 patients (6,8%) were hospitalized for HF and 14 (19.2%) needed diuretic therapy adjustment. There was a mortality of 2.7% (n=2). There were 3 cases of pruritus and 2 cases of genitourinary tract infection. There was a slight worsening of renal clearance (65.6±24.1 vs 60.9±24.6 ml/min/1,73 m²; p=0.001), however only 1 patient had a reduction >50% in the estimated GFR, like DAPA-HF trial (1.4% vs 1.2%). There was no need to discontinue the drug or hospitalization for adverse effects.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: Dapaglifozin in pts with optimized therapy, even if clinically stable, showed clinical and functional improvement, associated with a good safety profile. The similarity of the good results in the real world to the DAPA-HF trial highlights the importance of new therapies and the fight against therapeutic inertia.</span></span></p>
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