Abstract 16374: Effect of Dapagliflozin According to Duration of Heart Failure: An Analysis of the DAPA-HF Trial

Abstract

Introduction: The relationship between duration of heart failure (HF), patient characteristics, outcomes, and the effect of treatment is largely unknown. We investigated these questions in DAPA-HF. Hypothesis: We hypothesized that longer HF duration is associated with worse outcomes and that, compared with placebo, the benefit of the SGLT2 inhibitor, dapagliflozin, is consistent, irrespective of HF duration, in patients with HF and reduced ejection fraction (HFrEF). Methods: HF duration was categorised as 0-1, >1-2, >2-5 and >5 years. Outcomes were adjusted for prognostic variables and analysed using Cox regression. The primary endpoint was the composite of worsening HF or cardiovascular death. Treatment effect (dapagliflozin versus placebo) was examined within each duration category and by duration threshold. Results: The number patients in each category was: 1098 (0-1 year), 686 (>1-2 years), 1105 (>2-5 years) and 1855 (>5 years). Patients with longer-duration HF were older and more comorbid with worse quality of life. The primary outcome rate (per 100 person-years) increased with HF duration: 10.2 (95% CI 8.7-12.0) for the 0-1-year group, 10.6 (8.7-12.9) for >1-2 years, 15.5 (13.6-17.7) for >2-5 years and 15.9 (14.5-17.6) for >5 years. The adjusted hazard ratio was 0.98 (95% CI 0.75-1.27), 1.52 (1.22-1.89) and 1.60 (1.31-1.96) respectively, for >1-2, >2-5 and >5 years compared with 0-1 years. Similar trends were seen for all other outcomes. The benefit of dapagliflozin was consistent across HF duration for all outcomes and on threshold analysis (Figure). Conclusion: Patients with longer-duration HF had higher rates of worsening HF and death. The benefit of dapagliflozin was consistent irrespective of HF duration. Starting dapagliflozin has substantial benefits, even in patients with longstanding HFrEF.