Background and Importance Dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor authorised by the Spanish Medication and Healthcare Products Agency for chronic symptomatic heart failure (HF) with reduced left ventricular ejection fraction (LVEF). In the pivotal study DAPA-HF, the risk of cardiovascular death or worsening of the HF was reduced with dapaglifozin compared with placebo.
Aim and Objectives The objective of the study was to evaluate the use of dapagliflozin in a level four university hospital for HF indication according to the DAPA-HF study inclusion criteria, emergency room visits, and hospital readmissions due to HF decompensation, or death from any cause.
Material and Methods This was a retrospective study January-July 2021 that included HF patients with at least one dose of dapagliflozin. The variables recorded were: gender, age, LVEF, N-terminal B-type natriuretic peptide (NT-proBNP), standard treatment, HF classification according to the New York Heart Association (NYHA), readmissions/emergency room visits for HF, and death. The follow-up period lasted 14 months.
We evaluated whether the prescription of dapaglifozin met the inclusion criteria of the DAPA-HF study which were: LVEF ≤40%, NT-proBNP ≥600 pg/mL, NYHA class II-IV and standard therapy (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers or sacurbitril/valsartan, plus beta blockers and mineralocorticoid antagonists).
Results We had 51 patients (20% female) with an average age of 71 (49-88). Prescriptor adherence to all of the criteria was achieved in 30/51 patients (59%). Adherence for each criterion was: LVEF ≤ 40% in 46 patients (90%), NT-proBNP ≥ 600 pg/mL in 44 (86%), NYHA II-IV in 38 (74.5%) and adequate treatment with standard therapy in 45 (88%) patients.
Seventy-six percent (39/51) of patients continued with dapagliflozin at 14 months. During the follow-up period 10/51 visited an emergency room and 10/51 were readmitted for HF decompensation. The cause of death of three of the four patients who died was cardiovascular.
Conclusion and Relevance More than half of the prescriptions for dapagliflozin met the criteria for inclusion in the study. The percentage of HF decompensation or death from cardiovascular causes was greater in our cohort than in the clinical trial sample.
Conflict of Interest No conflict of interest
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