Effect of Dapagliflozin in DAPA-HF According to Background Glucose-Lowering Therapy
Authors: Docherty Kieran F. , Jhund Pardeep S. , Bengtsson Olof , DeMets David L. , Inzucchi Silvio E. , Køber Lars , Kosiborod Mikhail N. , Langkilde Anna Maria , Martinez Felipe A. , Sabatine Marc S. , Sjöstrand Mikaela , Solomon Scott D. , McMurray John J.V. ,   DAPA-HF Investigators and Committees, Diez Mirta , Sassone Sonia , Aizenberg Diego , Talavera Maria , Mercau Guillermo , Martinez Diego , Albisu Juan , Hershson Alejandro , GarcíaDurán Rubén , Hominal Miguel , Cluigt Natalia , ColomboBerra Fernando , Perna Eduardo , AhuadGuerrero Rodolfo , GarcíaBrasca Daniela , Zaidman Cesar , Majul Claudio , Taborda José , Luquez Hugo , Sala Jorgelina , SosaLiprandi Alvaro , Cursack Guillermo , Montaña Oscar , Fernandez AlbertoAlfredo , Najenson Martín , Nani Sebastian , Caruso Gustavo , Fairman Enrique , PereiroGonzalez Stella , Maia Lilia , Pereira Adamastor , Rossi Paulo , Precoma Dalton , Neuenschwander Fernando , Reis Gilmar , Guimaraes Fabio , Saraiva José , Arantes Flavia , Hernandes Mauro , Borges Joao , Paolino Bruno , Vasconcellos Eduardo , Manenti Euler , Pimentel Pedro , Leaes Paulo , Rassi Salvador , Dalcoquio Talia , Katova Tsvetana , Avramov Danail , Spasova Nataliya , Raev Dimitar , Chompalova Boryana , Milanova Maria , Tokmakova Maria , Runev Nikolai , Mihov Atanas , Gogov Antoni , Dincheva Adriana , Iliev Nikolay , Kolomanov Borislav , Ivanova Yuliyana , Ilieva Katya , Karageorgiev Dimitar , Petrov Ivan , Botushanov Nikolay , Vladeva Stefka , Constance Christian , Vizel Saul , Pandey Amritanshu , Phaneuf Denis-Carl , Mehta Shamir , Rupka Dennis , Pesant Yves , Poirier Paul , Chehayeb Raja , Babapulle Mohan , O’Meara Eileen , Howlett Jonathan , Yao Louis , McKelvie Robert , Verma Subodh , Hartleib Michael , Vijayaraghavan Ram , Vyselaar John , Azzari Fabian , Cha James , Nasser-Sharif Farah , Maung TunZan , Mansour Samer , Khaykin Yaariv , Lee Rina , Fong Peter , Ge Junbo , Jiang Hong , Li Xinli , Fu Lu , Li Ying , Wang Dongfang , Zhao Qiang , Dong Yugang , Zhou Yimeng , Lin Xiufang , Dong Jianzeng , Zhang Xiaoli , Zheng Zeqi , Huang Wenjun , Gu Ye , Liu Jinqiu , Guo Xueya , Wu Ling , Tang Qizhu , Peng Daoquan , Dong Wei , Liang Yingzi , Wang Daying , Wu Chun , Li Zhanquan , Lin Xuefeng , Zhang Xuelian , Wang Zhirong , Han Bing , Belohlavek Jan , Slaby Josef , Spinar Jindrich , Hajek Petr , Busak Ladislav , Carda Jiri , Spinarova Lenka , Malek Ivan , Skopek Jiri , Kuchar Roman , Krcova Eva , Mayer Otto , Kucera Dusan , Schou Morten , Køber Lars , Egstrup Kenneth , Hove JensDahlgaard , Gislason Gunnar , Videbæk Lars , Böhm Michael , Nischik Ruth , Toursarkissian Nicole , Appel Karl-Friedrich , Schmidt Ekkehard , Weigmann Ingo , Kellerer Monika , Al-Zoebi Ayham , Stephan Uta , Wilke Andreas , Genth-Zotz Sabine , Simonis Gregor , Tschöpe Diethelm , Costard-Jäckle Angelika , Petrie Mark , Gardner Roy , Clark Andrew , Japp Alan , Jhund Pardeep , Lang Chim , Leslie Stephen , Murphy Clare , Petrie Colin , Walsh John , Merkely Béla , Andrássy Péter , Noori Ebrahim , Járai Zoltán , Poór Ferenc , Király Csaba , Czigány Anna , Nagy László , Motyovszki Ákos , Masszi Gabriella , Mehta Vimal , Chopra V , Naik Ajay , Gadkari Milind , Sawant Rahul , Mahapekar Mashhadi , Karna Sunil , Deshpande Mukund , Bhargava Varun , Kothiwale Veerappa , Menon Jaideep , Sinha Dhurjati , Sinha Santosh , Kokane Hemant , Udgire Prashant , Sandhu Manjinder , Suzuki Masahiro , Nishino Masami , Kiyosue Arihiro , Sumii Kotaro , Suzuki Shu , Noguchi Yuichi , Tanaka Shinji , Takase Horoyuki , Mohri Masahiro , Higashiue Shinichi , Fujimoto Noritaka , Iseki Harukazu , Kuramochi Takehiko , Shibasaki Taro , Tsutsui Hiroshi , Takagi Yuichiro , Sakuragi Satoru , Takeyasu Noriyuki , Kitakaze Masahumi , Izumi Chisato , Oga Takafumi , Kimura Akira , Kakuta Tsunekazu , Hashimoto Tetsuo , Sugino Hiroshi , Saito Katsumi , Hiroi Shitoshi , kamiya Haruo , Fukui Kazuki , Matsuoka Satoshi , Moritani Kazunori , Tomobuchi Yoshiaki , Hata Yoshiki , Kawamura Ryo , Hattori Eijiro , Fujimoto Kazuteru , Takahashi Natsuki , Takahashi Wataru , Kadokami Toshiaki , Ueno Hideki , Uchikawa Shinichiro , Shinozaki Tsuyoshi , Onishi Yuko , Komiyama Nobuyuki , Inoue Shujiro , Momiyama Yukihiko , Ueda Yasunori , Komura Yasuo , Hayashida Ryo , Masuda Seigo , Higuchi Motoaki , Hayashi Yasushi , Seki Kozaburo , Fujii Kenshi , Harada Ken , Wada Atsuyuki , Kasai Takatoshi , Kuwahara Koichiro , Oishi Shogo , Uchida Issei , Okumura Yasuo , Hisamatsu Yuji , Nunohiro Tatsuya , Tsukahara Kengo , Hirohata Atsushi , Asakura Masanori , deBoer Rudolf , Bellersen Louise , Swart Henk , Groenemeijer Björn , ZoetNugteren Stieneke , deNooijer Cornelis(Ron) , Nierop Pieter , RoblesdeMedina Ramon , vanEck Jacob(Martijn) , vanHessen Maarten , Drożdż Jarosław , Miękus Paweł , Ściborski Ryszard , Mikłaszewicz Beata , Sudnik Wanda , Mariankowski Rafał , Witek Robert , Drelich Grzegorz , Mirek-Bryniarska Ewa , Szynal Sławomir , Pawłowicz Lidia , Lampart Jacek , Korzeniak Romuald , Prokopczuk Janusz , Boldueva Svetlana , Didenko Yury , Dzhaiani Nino , Ermoshkina Lyudmila , Kostenko Victor , Vishneva Elena , Koziolova Natalia , Tereschenko Sergey , Pevzner Dmitrii , Krylova Liudmila , Chernyavsky Alexander , Kazakov Andrei , Aksentiev Sergei , Nilk Rostislav , Paltsman Zhanna , Galyavich Albert , Maltcev Alexey , Kopylov Philipp , Ezhov Andrey , Shilko Julia , Antalik Lubomir , Bugan Viliam , Fulop Peter , Jamriskova Livia , Kollarova Daniela , Macek Vladimir , Slovenska Maria , Tomasova Livia , Vinanska Daniela , Smik Rudolf , Selecky Juraj , Majercak Ivan , Olexa Peter , Ljungman Charlotta , Hedman Anders , Lindholm Carl-Johan , Lindmark Krister , Mooe Thomas , Chiang Chern , Lin Lian-Yu , Liu Ming-En , Chang Kuan-Cheng , Hsia Chien-Hsun , Shih Jhih-Yuan , Liu Ping-Yen , Lin Tsung-Hsien , Chang Hung-Yu , Huang Jin-Long , Hsieh I-Chang , Wu Chih-Cheng , Tseng Wei-Kung , Arif Ahmed , Avino David , Banerjee Supratim , Kanwar Manreet , Berk Martin , Brown Christopher , Ince Carlos , Lewis Todd , Nikfarjam Akbar , Patel Jignesh , Ramanathan Kodangudi , Schabauer Alexander , Greene Trevor , Shah Keyur , Sotolongo Rodolfo , Viera Amado , Akinboboye Olakunle , Arouni Amy , Bertolet Barry , Chandra Lokesh , Cimato Thomas , DeLeon Samuel , Bennett Mosi , Franchi Francesco , Hamroff Glenn , Hotchkiss David , Jardula Michael , Javier Julian , Kazemi Navid , Kostis John , Lash Joseph , Levinson Lawrence , Lieber Ira , Lo Eric , Mahal Sharan , Manshadi Ramin , Mody Freny , Paraschos Alexander , Pursley Michael , Hickey Gavin , Londono Juan , Singal Dinesh , Srivastava Sunny , Teel Julie , Castriz Jorge , Kantaros Louis , Venugopal Chandra , Staniloae Cezar , Gupta Dinesh , Syed Faizullah , Zacharias Michael , Jaffrani Naseem , Wakefield Paul , Nassif Mike , Haddad Tariq , Iskander Sherif , Lewis Gregory , Al-Joundi Bassam , French William , Ogunniyi Modele , Emani Sitaramesh , Weiss Sara , Cheng Richard , Florea Viorel , Joseph Susan , Gupta Deepak , Lederman Samuel , Izzo Joseph , Bernstein Marc , Fruehling Erich , Foley Brian , Younis Liwa , Song David , Pham Vinh , Nguyen Hai , Do Huan , Truong Binh , Nguyen Hien , Nguyen Tuan , Nguyen Hien , Ho Dung 
Published: September 2020

OBJECTIVE
To determine whether the benefits of dapagliflozin in patients with heart failure and reduced ejection fraction (HFrEF) and type 2 diabetes in the Dapagliflozin And Prevention of Adverse-Outcomes in Heart Failure trial (DAPA-HF) varied by background glucose-lowering therapy (GLT).

RESEARCH DESIGN AND METHODS
We examined the effect of study treatment by the use or not of GLT and by GLT classes and combinations. The primary outcome was a composite of worsening heart failure (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death.

RESULTS
In the 2,139 type 2 diabetes patients, the effect of dapagliflozin on the primary outcome was consistent by GLT use or no use (hazard ratio 0.72 [95% CI 0.58–0.88] vs. 0.86 [0.60–1.23]; interaction P = 0.39) and across GLT classes.

CONCLUSIONS
In DAPA-HF, dapagliflozin improved outcomes irrespective of use or no use of GLT or by GLT type used in patients with type 2 diabetes and HFrEF.