DOI: 10.1161/circ.148.suppl_1.13640 ISSN: 0009-7322

Abstract 13640: Baseline Kidney Function and the Effects of Dapagliflozin on Health Status in Heart Failure: A Pooled Patient-Level Analysis From DFEINE-HF and PRESERVED-HF

Andrew P Ambrosy, Andrew J Sauer, Shachi Patel, Sheryl Windsor, Barry A Borlaug, Mansoor Husain, Silvio E Inzucchi, Dalane W Kitzman, Darren K McGuire, Sanjiv J Shah, Kavita Sharma, Guillermo Umpierrez, Mikhail N Kosiborod
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Sodium-glucose co-transport-2 (SGLT2) inhibitors have been shown to reduce clinical events and improve health status (symptoms, function, and quality of life) in patients with HF across the range of EF. Baseline kidney dysfunction is common in HF, complicates HF management, and is strongly linked to worse health status.

Aim: The study objective was to assess whether the treatment effects of dapagliflozin on health status vary based on baseline eGFR.

Methods: Patient-level data were pooled from the DEFINE-HF (N = 263 participants with EF

40%) and PRESERVED-HF trials (N = 324 participants with EF
45%). Both were double-blind, randomized trials of dapagliflozin vs. placebo, enrolling participants with NYHA class II or higher and elevated natriuretic peptides. The primary endpoint for this analysis was Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CCS) at 12 weeks. Interaction of dapagliflozin effects on KCCQ-CCS by baseline eGFR (mL/min/1.73m 2 ) was assessed as categorical (i.e., eGFR <60 vs.
60) and continuous variables.

Results: Across both trials there were 583 (99.3%) participants with available baseline eGFR. The median (25 th , 75 th ) eGFR was 59 (46,77). Dapagliflozin improved KCCQ-CSS at 12 weeks (placebo-adjusted difference, +5.0 points, 95% Confidence Interval [CI] 2.6-7.5; p-value <0.001), and this was consistent in participants with an eGFR

60 (+6.0 points, 95% CI 2.4-9.7; p=0.001) and <60 (+4.1 points, 95% CI 0.5-7.7; p=0.025) (p-interaction = 0.46). The benefits of dapagliflozin on KCCQ-CSS were robust across eGFR when modeled continuously (p-interaction = 0.46) ( Figure ). There was no heterogeneity of treatment effects when analyzing other KCCQ domains based on eGFR categorically or continuously (all p-interaction = NS).

Conclusion: Treatment with dapagliflozin for 12 weeks led to significant and consistent improvements in health-related quality of life in patients with HF across a wide range of eGFRs.

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