Abstract Aims In the DAPA-HF trial, the SGLT2 inhibitor dapagliflozin reduced the risk of worsening heart failure (HF) and death in patients with HF and reduced ejection fraction. We examined whether this benefit was consistent in relation to background HF therapy. Methods and results In this post hoc analysis, we examined the effect of study treatment in the following yes/no subgroups: diuretic, digoxin, mineralocorticoid receptor antagonist (MRA), sacubitril/valsartan, ivabradine, implanted cardioverter-defibrillating (ICD) device, and cardiac resynchronization therapy. We also examined the effect of study drug according to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker dose, beta-blocker (BB) dose, and MRA (≥50% and <50% of target dose). We analysed the primary composite endpoint of cardiovascular death or a worsening HF event. Most randomized patients (n = 4744) were treated with a diuretic (84%), renin–angiotensin system (RAS) blocker (94%), and BB (96%); 52% of those taking a BB and 38% taking a RAS blocker were treated with ≥50% of the recommended dose. Overall, the dapagliflozin vs. placebo hazard ratio (HR) was 0.74 [95% confidence interval (CI) 0.65–0.85] for the primary composite endpoint (P < 0.0001). The effect of dapagliflozin was consistent across all subgroups examined: the HR ranged from 0.57 to 0.86 for primary endpoint, with no significant randomized treatment-by-subgroup interaction. For example, the HR in patients taking a RAS blocker, BB, and MRA at baseline was 0.72 (95% CI 0.61–0.86) compared with 0.77 (95% CI 0.63–0.94) in those not on all three of these treatments (P-interaction 0.64). Conclusion The benefit of dapagliflozin was consistent regardless of background therapy for HF.

中文翻译：

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根据背景心力衰竭治疗，达格列净对 DAPA-HF 的影响


摘要 目的 在 DAPA-HF 试验中，SGLT2 抑制剂达格列净可降低射血分数降低的心力衰竭 (HF) 患者心力衰竭 (HF) 恶化和死亡的风险。我们检查了这种益处与背景心力衰竭治疗是否一致。方法和结果 在这项事后分析中，我们检查了研究治疗在以下是/否亚组中的效果：利尿剂、地高辛、盐皮质激素受体拮抗剂 (MRA)、沙库巴曲/缬沙坦、伊伐布雷定、植入式心律转复除颤 (ICD) 装置、和心脏再同步治疗。我们还根据血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂剂量、β-受体阻滞剂（BB）剂量和MRA（≥目标剂量的50%和<50%）检查了研究药物的效果。我们分析了心血管死亡或心力衰竭事件恶化的主要复合终点。大多数随机患者 (n = 4744) 接受利尿剂 (84%)、肾素-血管紧张素系统 (RAS) 阻滞剂 (94%) 和 BB (96%) 治疗； 52% 服用 BB 的患者和 38% 服用 RAS 阻滞剂的患者接受了≥50% 推荐剂量的治疗。总体而言，达格列净与安慰剂的主要复合终点风险比 (HR) 为 0.74 [95% 置信区间 (CI) 0.65–0.85] (P < 0.0001)。达格列净的效果在所有检查的亚组中均一致：主要终点的 HR 范围为 0.57 至 0.86，亚组之间没有显着的随机治疗相互作用。例如，基线时服用 RAS 阻滞剂、BB 和 MRA 的患者的 HR 为 0.72 (95% CI 0.61–0.86)，而未接受所有这三种治疗的患者的 HR 为 0.77 (95% CI 0.63–0.94) (P -交互作用0.64)。结论 无论心力衰竭的背景治疗如何，达格列净的益处都是一致的。