Benefits of Dapagliflozin in the Whole Spectrum of Heart Failure in Clinical Practice: The RICA Registry

Montero-Pérez-Barquero, Manuel; Cervantes, C. Escobar; Dávila‐Ramos, Melitón Francisco; Suárez-Pedreira, Iván; Pérez-Silvestre, José; Ceresuela-Eito, Luis; Muela-Molinero, Alberto; Quesada-Simón, María Angustias; Formiga, Francesç; González-Franco, Álvaro; Casado, Jesús

doi:10.2217/fca-2023-0014

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…Moreover, patients had numerous comorbid conditions. In the RICA registry, which included patients aged ≥50 years admitted with HF to internal medicine departments in Spain between 2008 and 2019, the mean age was 80 years, up to a third of patients were in functional class III, more than 60% had HFpEF, and comorbidity was very common [ 17 ]. Various studies have indicated that in clinical practice, a high number of patients with HF would be eligible for treatment with SGLT2i [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Progress of patients hospitalized with acute heart failure treated with empagliflozin

Raya-Cruz,

Jurado,

de la Torre Peregrín

et al. 2024

J. Comp. Eff. Res.

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Aim: To describe the epidemiological, clinical and laboratory characteristics and clinical progress of patients hospitalized with heart failure (HF) who started treatment with empagliflozin before discharge. Methods: We performed a retrospective observational study of patients aged ≥18 years admitted to the Internal Medicine Department of University Hospital Jaen, Jaen, Spain with acute HF between 1 May 2022 and 31 May 2023. Patients had to have a life expectancy of ≥1 year and have started treatment with empagliflozin during admission. Results: We included 112 patients (mean age, 85.2 ± 6.5 years; 67.9% women; 35.7 and 31.3% in NYHA functional classes III and IV; 73.2% with HF and preserved ejection fraction). Before admission, 80.4% were taking loop diuretics, 70.6% renin–angiotensin–aldosterone system inhibitors, 49.1% betablockers and 25% mineralocorticoid receptor antagonists. At admission, 94.6% were taking furosemide (15.2% at high doses, 36.6% at intermediate doses). The dose of furosemide was reduced at initiation of empagliflozin. At the end of follow-up, 13.4% of patients had died, 93.8% of the survivors continued treatment with empagliflozin and 26.8% had attended the emergency department with signs and symptoms of HF. Conclusion: Introduction of empagliflozin before discharge from hospital in patients admitted with HF made it possible to reduce the dose of diuretics during admission. The frequency of complications was as expected, and treatment was largely maintained.

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Section: Discussionmentioning

confidence: 99%

Progress of patients hospitalized with acute heart failure treated with empagliflozin

Raya-Cruz,

Jurado,

de la Torre Peregrín

et al. 2024

J. Comp. Eff. Res.

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“…Robust evidence from clinical trials and sub-studies has demonstrated that dapagliflozin reduces not only HF (re-)hospitalizations, but also cardiovascular mortality (NNT = 68) and all-cause death (NNT = 67) in the whole spectrum of HF, without a loss of efficacy according to ejection fraction [92]. On the other hand, different studies have shown that a great proportion of patients with HF in clinical practice are eligible for dapagliflozin according to the DAPA-HF and DELIVER criteria [102][103][104][105][106][107][108]. In addition, the full implementation of dapagliflozin in real-life populations would prevent/postpone new worsening HF events or even death [102,[106][107][108].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, different studies have shown that a great proportion of patients with HF in clinical practice are eligible for dapagliflozin according to the DAPA-HF and DELIVER criteria [102][103][104][105][106][107][108]. In addition, the full implementation of dapagliflozin in real-life populations would prevent/postpone new worsening HF events or even death [102,[106][107][108]. For example, a Spanish registry of 5644 patients ≥50 years old consecutively hospitalized for HF in internal medicine departments in Spain showed that full implementation of dapagliflozin would lead to robust absolute risk reductions of mortality and HF readmission, with low NNT in patients with HF, regardless ejection fraction (Figure 7) [106][107][108].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the full implementation of dapagliflozin in real-life populations would prevent/postpone new worsening HF events or even death [102,[106][107][108]. For example, a Spanish registry of 5644 patients ≥50 years old consecutively hospitalized for HF in internal medicine departments in Spain showed that full implementation of dapagliflozin would lead to robust absolute risk reductions of mortality and HF readmission, with low NNT in patients with HF, regardless ejection fraction (Figure 7) [106][107][108]. These clinical beneficial effects of dapagliflozin rely on several pathophysiologica mechanisms that have been investigated in different experimental and clinical studies Thus, experimental studies have shown in different animal models with HF that dapagli flozin inhibits ventricular remodeling, attenuates cardiometabolic dysregulation and dia betes-induced diastolic dysfunction, reduces cardiac fibrosis and inflammation, improve These clinical beneficial effects of dapagliflozin rely on several pathophysiological mechanisms that have been investigated in different experimental and clinical studies.…”

Section: Discussionmentioning

confidence: 99%

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Current Role of SLGT2 Inhibitors in the Management of the Whole Spectrum of Heart Failure: Focus on Dapagliflozin

Escobar,

Pascual-Figal,

Manzano

et al. 2023

JCM

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Heart failure (HF) is associated with a high morbidity and mortality burden. In light of more recent evidence, SGLT2 inhibitors are currently recommended as first-line therapy in managing patients with HF, regardless of ejection fraction, to reduce HF burden. The DAPA-HF and DELIVER trials, and particularly, the pooled analysis of both studies, have shown that dapagliflozin significantly reduces the risk of cardiovascular death, all-cause death, total HF hospitalizations, and MACE in the whole spectrum of HF, with sustained benefits over time. Recent data have shown that the full implementation of dapagliflozin in clinical practice would translate into a robust reduction in hospitalizations for HF and death in real-life populations. Many pathophysiological mechanisms have been involved in these benefits, particularly the positive effects of dapagliflozin on reversing cardiac (atrial and ventricular) remodeling, reducing cardiac fibrosis and inflammation, and improving endothelial dysfunction. In this manuscript, we reviewed from a practical point of view the role of dapagliflozin in the management of the whole spectrum of patients with HF.

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Projected Clinical Benefits of Dapagliflozin in Patients with Heart Failure with Preserved Ejection Fraction

Montero-Pérez-Barquero

Cervantes

Llàcer

et al. 2023

Future Cardiol.

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Aims: To address the projected clinical benefits of dapagliflozin among patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). Methods: A multicenter, prospective, cohort study of patients ≥50 years admitted with HF to Spanish internal medicine departments. The projected clinical benefits of dapagliflozin were calculated from the DELIVER trial. Results: A total of 4049 patients were included; 3271 (80.8%) were eligible for dapagliflozin treatment, according to DELIVER criteria. Within 1 year after discharge, 22.2% were rehospitalized for HF and 21.6% died. Implementation of dapagliflozin would translate into an absolute risk reduction of 1.3% for mortality and 5.1% for HF readmission. Conclusion: HF patients with preserved or mildly reduced ejection fraction have a high risk of events. The use of dapagliflozin could substantially reduce the HF burden.

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Benefits of Dapagliflozin in the Whole Spectrum of Heart Failure in Clinical Practice: The RICA Registry

Cited by 5 publications

References 36 publications

Progress of patients hospitalized with acute heart failure treated with empagliflozin

Progress of patients hospitalized with acute heart failure treated with empagliflozin

Current Role of SLGT2 Inhibitors in the Management of the Whole Spectrum of Heart Failure: Focus on Dapagliflozin

Projected Clinical Benefits of Dapagliflozin in Patients with Heart Failure with Preserved Ejection Fraction

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