3. SGLT-2 Inhibitors: Proposed Mechanism(s) of Action for HF Benefit
HF
Benefit
Decreased
pre and
afterload
Improvement
in cardiac
metabolism
Myocardial
Na+/H+
exchange
inhibition
Decreased
cardiac
fibrosis
Decreased
inflammation
and epicardial
adipose tissue
4. DAPA-HF: Methodology
Inclusion Criteria
• 18 years old
• EF ≤ 40%
• NYHA II-IV
• NT-proBNP 600 pg/mL
• Receiving GDMT
Exclusion Criteria
• Recent treatment with
SGLT2 inhibitor
• Type 1 diabetes
• Symptomatic hypotension or
SBP < 95 mm Hg
• GFR < 30 mL/min/1.73 m2
of BSA
• Enrollment:
5.
6.
7. DAPA-HF: Intervention and Monitoring
Action
First Follow-Up
at 14-days
14-Day
Screening Randomization
Period
Inclusion/
Exclusion Applied
Dapagliflozin 10
mg once daily
Patient Stable
Next follow-up at
60 days
Decline in GFR,
volume depletion,
hypotension
Dose reduction to
discontinuation
5 mg daily OR
^
Placebo Assessment Next follow-up at
60 days
^ Subsequent increase in dose or reinitiation of treatment if possible
GFR: glomerular filtration rate
8.
9.
10.
11.
12. • Composite: worsening HF or CV death
• Worsening HF = unplanned hospitalization or an urgent visit
resulting in IV therapy for heart failure
Primary
Outcome
• Composite: HF hospitalization or CV death
• Each component alone
• KCCQ: change from baseline to 8 months
• Composite: worsening renal function, end stage renal disease,
or renal death
Secondary
Outcomes
• Serious adverse events
Safety
Outcomes
13. Discontinued
Treatment or
Incomplete Follow-Up
Treatment Group
Randomization
Screening
8134
patients
4744
patients
2371
placebo
261 patients
2373
dapagliflozin
254 patients
3390
excluded
Reasons for
Exclusion:
12 died
15 adverse event
84 declined
3279 did not meet
eligibility criteria
