Comparative effectiveness of dapagliflozin vs . empagliflozin on major adverse cardiovascular events in patients with heart failure with reduced ejection fraction: A real‐world prospective cohort study
Tuong Le Trong Huynh, Hien Dieu Tran, Phong Thanh Pham, Nhan Dinh Tran, Nhan Thanh Nguyen, Huyen Doan Thi Bich Cao, Son Ngoc Nguyen, Anh Phuoc Lan Nguyen, Thoai Anh Nguyen, Sang Phu Bui, Trung Quang Le, Toan Hoang Ngo, Son Kim TranAbstract
Background
Dapagliflozin and empagliflozin are sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) with equivalent Class IA guideline recommendations in heart failure with reduced ejection fraction (HFrEF).
Objectives
To compare the incidence of major adverse cardiovascular events (MACE) between dapagliflozin and empagliflozin in HFrEF patients treated in routine clinical practice.
Methods
This prospective real‐world cohort study enrolled 1231 consecutive HFrEF patients (left ventricular ejection fraction ≤40%) at Can Tho Central General Hospital, Vietnam (March 2023 to March 2026). Patients received dapagliflozin ( n = 622) or empagliflozin ( n = 609) as part of optimized guideline‐directed medical therapy and the primary outcome was MACE.
Results
MACE occurred in 64 patients (10.3%) receiving dapagliflozin and 111 patients (18.2%) receiving empagliflozin. Following propensity score matching and multivariable adjustment, dapagliflozin was associated with significantly lower odds of MACE (adjusted odds ratio [OR] 0.46; 95% confidence interval [CI] [0.30, 0.67]; p < 0.001). Hospitalization for heart failure was significantly lower with dapagliflozin (8.7% vs . 14.9%; adjusted OR 0.52; 95% CI [0.33, 0.80]; p = 0.003). Corrected all‐cause mortality was 13/622 (2.1%) with dapagliflozin and 25/609 (4.1%) with empagliflozin ( p = 0.048). Multivariable logistic regression identified four independent predictors of MACE: New York Heart Association functional class III‐IV (adjusted OR 15.54; 95% CI [9.09, 28.99]; p < 0.001), sedentary lifestyle (adjusted OR 2.11; 95% CI [1.42, 3.37]; p < 0.001), premature cardiovascular disease history (adjusted OR 2.30; 95% CI [1.29, 4.43]; p = 0.007) and dapagliflozin as an independent protective factor (adjusted OR 0.47; 95% CI [0.31, 0.68]; p < 0.001).
Conclusions
In this real‐world prospective Vietnamese HFrEF cohort followed over 36 months, dapagliflozin was associated with significantly lower odds of MACE and HF hospitalization compared with empagliflozin, with robust adjustment for confounding.