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evident
Original paper
2022NEJMCardiology

DELIVER

Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction

RCTHFpEF/HFmrEF

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Overview

Dapagliflozin reduced worsening HF or CV death in HF with mildly reduced or preserved EF.

Clinical takeaway

DELIVER confirmed SGLT2 inhibitor benefit across the higher-EF heart-failure spectrum, pairing with EMPEROR-Preserved.

Key result

Worsening HF or CV death was reduced with dapagliflozin; HR 0.82.

Practice impact

SGLT2 inhibitors became foundational therapy across much of the EF spectrum.

Evidence

Study design

Randomized, double-blind, placebo-controlled trial.

Enrollment

6,263

Follow-up

Median 2.3 years.

Geography

Multinational

Clinical question

Does dapagliflozin improve outcomes in heart failure with mildly reduced or preserved ejection fraction?

Population

  • Symptomatic heart failure patients with left ventricular ejection fraction greater than 40%.

Intervention

Dapagliflozin 10 mg daily.

Comparator

Placebo.

Primary outcome

Composite of worsening heart failure or cardiovascular death.

Dapagliflozin reduced worsening heart failure or cardiovascular death in HFmrEF/HFpEF.

Hazard ratio / 0.82 / 95% CI 0.73-0.92 / p<0.001

Key results

  • Primary composite: HR 0.82; 95% CI 0.73-0.92.
  • Benefit was driven largely by reduced worsening heart failure.
  • Benefit was consistent in patients with and without diabetes.

Harms

  • Genital mycotic infection, volume depletion, and rare ketoacidosis are practical SGLT2 inhibitor concerns.

Clinical Use

Practice impact

  • Strengthened guideline recommendations for SGLT2 inhibitors in HFpEF/HFmrEF.

Applicability

  • Symptomatic heart failure with EF above 40%, regardless of diabetes status, if renal function and adverse-effect profile permit.

Limitations

  • Absolute benefit depends on baseline HF event risk.
  • Does not replace diuretics for congestion.

Common misinterpretations

  • Do not describe SGLT2 inhibitors as diabetes drugs only; heart-failure benefit extends beyond diabetes.

Related evidence

EMPEROR-Preserved - Similar QuestionDAPA-HF - Same Drug Class

Citation

Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286

Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction.