FORXIGA is the first SGLT2 inhibitor approved by BPOM for the treatment of symptomatic chronic stable heart failure with reduced ejection fraction, as an adjunct to standard of care therapy. A study found that FORXIGA reduced the risk of the primary composite outcome in patients with heart failure with reduced ejection fraction. Additionally, treatment with FORXIGA resulted in a clinically meaningful improvement in heart failure symptoms and quality of life as measured by the Kansas City Cardiomyopathy Questionnaire.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Insights from the FIGARO-DKD and FIDELIO-DKD trials - Dr. GawadNephroTube - Dr.Gawad
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/kanEHVsStsI
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Silvio E. Inzucchi, MD, prepared useful Practice Aids pertaining to type 2 diabetes management for this CME activity titled "The Role of SGLT2 Inhibitors in Type 2 Diabetes: CV, Metabolic, and Renal Considerations." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2l4h3Ss. CME credit will be available until June 27, 2019.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Insights from the FIGARO-DKD and FIDELIO-DKD trials - Dr. GawadNephroTube - Dr.Gawad
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/kanEHVsStsI
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Silvio E. Inzucchi, MD, prepared useful Practice Aids pertaining to type 2 diabetes management for this CME activity titled "The Role of SGLT2 Inhibitors in Type 2 Diabetes: CV, Metabolic, and Renal Considerations." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2l4h3Ss. CME credit will be available until June 27, 2019.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Acute Heart Failure: Current Standards and Evolution of Care.2015hivlifeinfo
Обсуждение последних данных, касающиеся диагностики и лечения острой сердечной недостаточности, в том числе использование биомаркеров для диагностики и оценке прогноза , преимущества и ограничения действующих стандартами медицинской помощи, и доказательств данных по современной терапии острой сердечной недостаточности.
Формат: Microsoft PowerPoint (.ppt)
Размер файла: 1.68 Мб
Дата публикации: 7/24/2015
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
HF.pptx
1. 1
NEW INDICATION
ID-3774 / Oct 2023
2
FORXIGA is the FIRST SGLT2i approved by BPOM, indicated in adults for
the treatment of symptomatic chronic stable heart failure (NYHA functional
class (II-III) with reduced ejection fraction (left ventricular ejection fraction
(LVEF) < 40%), as an adjunct to standard of care therapy. 1
1. FORXIGA Approve Product Information 2 . McMurray JJV et al. N Engl J Med. 2019;381(21):1995–2008.3. ESC
Guideline 2021.
2. New Indication
FORXIGA® is THE FIRST AND ONLY SGLT2i approved by BPOM, indicated for the treatment of
Symptomatic chronic stable heart failure (NYHA II-III) with reduce ejection fraction, as an adjunct to
standard of care therapy2
1. McMurray JJV et al. N Engl J Med. 2019;381(21):1995–2008. 2. Berg DD et al. JAMA Cardiol. 2021;6(5):499–507
3. 3
NEW INDICATION
ID-3765/Oct 2023
2
FORXIGA is the FIRST SGLT2i approved by BPOM, indicated in adults for
the treatment of symptomatic chronic stable heart failure (NYHA functional
class (II-III) with reduced ejection fraction (left ventricular ejection fraction
(LVEF) < 40%), as an adjunct to standard of care therapy. 1
1. FORXIGA Approve Product Information 2 . McMurray JJV et al. N Engl J Med. 2019;381(21):1995–2008.3. ESC
4. 32% of
patients
Nearly one-third of patients
with HFrEF are at high risk
of hospitalisation or CV death,
including those who appear stable2
Based on NYHA classification over
a 4-year period, from the 2004 CHARM study
Patients with hHF/CV death
Patients event free
HF patients are at very high risk of death and hospitalisation
aBased on a prospective observational study of 3494 US outpatients with chronic HFrEF in the CHAMP-HF registry; bBased on a retrospective analysis of 51,286 patients from a US Military Data Repository admitted to a healthcare facility
for the first time for heart failure. During the 7-year study period (2007–2013), patients were assessed for subsequent hHF, comorbidities,
and mortality data. No distinction was made between patients with reduced or preserved ejection fraction
CV, cardiovascular; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; hHF, hospitalisation for heart failure; NYHA,
New York Heart Association; SoC, standard of care
1. Khariton Y, et al. JACC Heart Fail 2018:6;465–473; 2. Young JB, et al. Circulation 2004;110:26182626; 3. Lin AH, et al. Mil Med 2017;182:e1932–e1937
are symptomatic,
even with current
HF SoC1,a
Each hHF increases
the risk of mortality further3,b
9out of10
PATIENTS
5. Pharmacological treatment of HF in Asian Countries and
Current Common Treatments for HF
1. Ponikowski P, et al. Eur J Heart Fail 2016;37:2129–2200; 2. Reyes, E. B., Ha, J. W., Firdaus, I., Ghazi, A. M., Phrommintikul, A., Sim, D., Vu, Q. N., Siu, C. W., Yin, W. H., & Cowie, M. R. (2016). Heart failure across Asia: Same
healthcare burden but differences in organization of care. International journal of cardiology, 223, 163–167. https://doi.org/10.1016/j.ijcard.2016.07.256 ;
Suboptimal treatment Clinical Inertia
may leads to
Pharmacological
treatment of HF
Indonesia Malaysia Singapore Europe
RAAS inhibitor 78% 67% 74% 89%
β – blocker 32% 72% 65% 87%
Calcium channel blocker - 17% - 10%
Ivabradine - - - -
Diuretic 78% 99% 87% 83%
Digoxin 21% 44% 27% 21%
Lipid-lowering agent - 76% 72% 54%
Anticoagulant - 25% 12% 43%
Pharmacological treatment of HF in some countries or region2
• ACE inhibitor
• ARB
• β blocker
• Loop diuretic
• Mineralocorticoid antagonist
• Sacubitril/valsartan
Current common
treatments for HF1,a
6. The ESC has recognised the benefits of dapagliflozin
in patients with HFrEF
ESC, European Society of Cardiology; HF, heart failure; HFrEF, heart failure with reduced ejection fraction
1. Seferović PM, et al. Eur J Heart Fail 2020;22:1495–1503; 2. McMurray JJV, et al. N Engl J Med 2019;381:1995–2008; 3. Petrie MC, et al. JAMA 2020;323:1353–1368;
4. Solomon SD, et al. JACC Heart Fail 2020;S2213–1779:30254–7 [Epub ahead of print]; 5. Docherty KF, et al. Eur Heart J 2020;41:2379–2392; 6. Dewan P, et al. Eur J Heart Fail 2020;22:1247–1258
“The benefit of dapagliflozin on reducing important clinical events was seen
within weeks of its initiation. Given that HF is associated with severely
impaired survival, a timely initiation of an agent with a proven benefit
on outcomes is of a crucial clinical importance” 1
2020 position statement
Sustained efficacy1 Consistent efficacy
across subgroups2–6
Patients live and feel better
7. Therapeutic algorithm of Class I Therapy Indications for a
patient with heart failure with reduced ejection fraction
European Heart Journal, Volume 42, Issue 36, 21 September 2021, Pages 3599–3726
Dapagliflozin is now
considered to be part of the
management of HFrEF
Class I A
8. 1. McMurray JJV et al. N Engl J Med. 2019;381(21):1995–2008. 2. Berg DD et al. JAMA Cardiol. 2021;6(5):499–507.
In DAPA-HF, dapagliflozin reduced the risk of the primary composite
outcome in patients with HFrEF
9. 1. McMurray JJV et al. N Engl J Med. 2019;381(21):1995–2008.2. McMurray JJV. Oral presentation at the European Society of Cardiology Annual Meeting; 31 August –4 September 2019;
Paris, France. Hot Line Session
10. 1. Petrie MC et al. JAMA. 2020;323(14):1353–1368
11. The KCCQ is a patient self-administered instrument
that measures QoL in patients with HF
KCCQ, Kansas City Cardiomyopathy Questionnaire; HF, heart failure, QoL, quality of life
US Food and Drug Administration. Available at: https://www.fda.gov/media/108301/download#:~:text=KCCQ%20Symptom%20Domain%20quantifies%20the,and%20severity%20are%20also%20available
(Accessed March 2021)
What is the KCCQ?
Self-administered questionnaire
measuring patient perception of HF
impact on six domains:
• Physical function/limitations
• Symptoms
• Symptom stability
• Social interference
• Quality of life
• Self-efficacy
Oedema
Dyspnoea
Fatigue
Shortness of breath
Key HF symptoms
12. Dapagliflozin improved patient QoL from baseline to month 4
and sustained the improvement at month 8
Exploratory post hoc analysis:
Change in KCCQ-OSS from baseline1,a
Patients taking FORXIGA reported a significant
reduction in physical and social limitations,
allowing them to live life more fully1
Time from randomisation
Baseline 4 months 8 months
Secondary endpoint:
Treatment with FORXIGA resulted in a clinically
meaningful benefit over placebo in heart failure
symptoms, as measured by change from baseline
at month 8
in the KCCQ-TSS
(Win ratio: 1.18 [95% CI: 1.11, 1.26]; P<0.0001)2
aThe key secondary endpoint was the KCCQ-TSS. A total of 4443 patients had available KCCQ data at baseline; of these, 4141 and 3955 patients had KCCQ data evaluated at 4 and 8 months, respectively. Treatment with dapagliflozin
resulted in a clinically meaningful benefit over placebo in heart failure symptoms, as measured by change from baseline at month 8 in the KCCQ-TSS (Win ratio: 1.18 [95% CI: 1.11, 1.26]; P<0.0001). A change in 5 points in the KCCQ-OSS
is generally considered to be clinically meaningful
CI, confidence interval; KCCQ, Kansas City Cardiomyopathy Questionnaire; OSS, Overall Summary Score; QoL, quality of life; SoC, standard of care; TSS, Total Symptom Score
1. Kosiborod MN, et al. Circulation 2020;141:90–99; 2. AstraZeneca AB. Forxiga 10 mg EU Summary of Product Characteristics, 2020. Available at: https://www.medicines.org.uk/emc/product/7607/smpc#CLINICAL_PRECAUTIONS
(Accessed March 2021)
Adjusted
mean
KCCQ
score
85
80
75
70
65
60
1.7439
P<0.0001
2.3114
P<0.0001
0
Forxiga helped patients feel better and do more
FORXIGA with SoC
Placebo with SoC
13. Data are based on an exploratory post hoc analysis of 4443 patients
CI, confidence interval; ESC, European Society of Cardiology; KCCQ, Kansas City Cardiomyopathy Questionnaire; HFrEF, heart failure with reduced ejection fraction; OR, odds ratio;
QoL, quality of life; TSS, Total Symptom Score
1. Kosiborod MN, et al. Circulation 2020;141:90–99; 2. Seferović PM, et al. Eur J Heart Fail 2020;22:1495–1503
2020 position statement
A sub-analysis of the DAPA-HF trial
demonstrated dapagliflozin can
produce a significant improvement
in quality of life as assessed
by the KCCQ in patients with HFrEF,
which is of high clinical value2
50.9
47.6 48.2
58.30
54.50 54.00
0
10
20
30
40
50
60
70
80
Patients
(%)
≥5 points ≥15 points
≥10 points
P<0.0001 P<0.0001
P<0.0001
OR 1.15
95% CI: 1.08, 1.23
OR 1.15
95% CI: 1.08, 1.22
OR 1.14
95% CI: 1.07, 1.22
Dapagliflozin
Placebo
Improvement in KCCQ-TSS from baseline to month 81
Increase in KCCQ-TSS
Dapagliflozin improved patient QoL from baseline to 8 months
15. Adverse Effect of dapagliflozin1
*Reported in ≥2% of subjects and ≥1% more and at least 3 more subjects treated with dapagliflozin 10 mg compared to placebo.
**Reported by the investigator as possibly related, probably related or related to study treatment and reported in ≥ 0.2% of subjects and ≥ 0.1% more and at least 3 more subjects treated with dapagliflozin 10 mg
compared to placebo
GI: Gastrointestinal; UTI: Urinary Track Infection.
Reference: 1. FORXIGA Approved Product Information
System organ class Very common Common* Uncommon** Rare
Infections and infestations Vulvovaginitis,
balanitis, and related
genital infections*;
UTI*
Fungal infection**
Metabolism and nutrition
disorders
Hypoglycaemia
(when used with SU
or insulin)
Volume depletion;
Thirst**
Diabetic
ketoacidosis
Nervous system disorders Dizziness
GI disorders Constipation**;
dry mouth**
Skin and subcutaneous
tissue disorders
Rash
Musculoskeletal and
connective tissue disorders
Back pain*
Renal and urinary disorders Dysuria polyuria* Nocturia**
Reproductive system
and breast disorders
Vulvovaginal
pruritus**;
pruritus genital**
Investigations ↑ haematocrit;
↓ creatinine renal
clearance during
initial treatment;
dyslipidaemia
↑ blood creatinine;
↑ blood urea**;
↓ weight**
16. 1. McMurray JJV et al. N Engl J Med. 2019;381(21):1995–2008. 2. Forxiga Approved Product Information
≥30 ml/min/1.73m2
Editor's Notes
Even with the current standard-of-care treatments for HF, nine out of ten patients remain symptomatic, underlining the unmet need for newer HF treatments
Patients with HFrEF are at high risk for hospitalisation for HF, even when they are treated with current standard-of-care medications and appear to be stable
Furthermore, with each hospitalisation, the risk of death increases
The beneficial effects of dapagliflozin that were seen in the DAPA-HF trial have been recognized by the ESC
The ESC have highlighted the ‘crucial clinical importance’ of timely initiation of dapagliflozin in patients with HF
The KCCQ is a tool that is often used as a quality-of-life measure in patients with HF, allowing evaluation of the impact of HF from a patient perspective
In a post hoc analysis of patients from the DAPA-HF trial, the KCCQ was used to measure the impact of dapagliflozin treatment versus placebo on patients’ quality of life
Dapagliflozin was shown to significantly improve patients’ quality of life at both 4 and 8 months versus placebo
Improvements in quality of life mean that patients are able to live a more normal life, taking part in activities such as walking and gardening
The benefits of dapagliflozin in improving patients’ quality of life have been recognized by the ESC, which has noted the high clinical value of this measure