A multicenter study finds that dapagliflozin benefits patients after admission to the hospital for acute heart failure.

Summary: A multicenter study has identified dapagliflozin, a drug initially approved for type 2 diabetes, as a potential treatment for acute heart failure. Published in the Journal of the American College of Cardiology, the research shows dapagliflozin can improve diuresis and reduce hospital stays by effectively managing fluid buildup in the lungs. The study, which involved 240 patients at various sites, demonstrated the drug’s safety and efficacy when administered early during hospitalization.

Key Takeaways:

  • Originally approved for type 2 diabetes, dapagliflozin has been identified as a potential treatment for acute heart failure, demonstrating the ability to improve diuresis and reduce hospital stays.
  • Published in the Journal of the American College of Cardiology, the study showed that initiating dapagliflozin early during hospitalization for acute heart failure could lead to better patient outcomes and might have international implications for treatment protocols.
  • The multicenter trial involved 240 patients and was conducted despite the challenges posed by the COVID-19 pandemic. The research concluded that dapagliflozin is safe and effective for acute heart failure patients, potentially easing symptoms and shortening hospital stays without increasing adverse events.

A multicenter study has identified dapagliflozin, originally approved for type 2 diabetes, as a potential new treatment for acute heart failure, a leading cause of hospitalization and death.

Dapagliflozin has previously been shown to reduce the risk of hospitalization for heart failure and death in patients with serious health problems that include heart and chronic kidney disease and heightened cardiovascular risk.

Study Findings on Dapagliflozin

Reporting in the Journal of the American College of Cardiology, the researchers found that dapagliflozin also benefits patients after admission to the hospital for acute heart failure. The drug improves diuresis, the elimination of excess fluid from the lungs, thereby relieving congestion, and it can reduce hospital stays.

“We demonstrated safety and efficacy of initiating dapagliflozin within the first day of hospitalization for acute heart failure,” says the paper’s first author, Zachary Cox, PharmD, professor of pharmacy practice at Lipscomb University, in a release. This “will have international impact on the treatment of acute heart failure.” 

Each year 800,000 patients with acute heart failure are admitted to US hospitals from emergency rooms. These patients are at high risk for prolonged hospital stays and death. The annual cost of treating acute heart failure in the United States is estimated to exceed $34 billion. 

Challenges in Current Heart Failure Treatments

Diuretics are administered to most patients with acute heart failure to improve symptoms and lung congestion caused by fluid buildup. However, the optimal approach to diuretic therapy in patients hospitalized for acute heart failure remains poorly defined and contributes to prolonged inpatient stays and high death and readmission rates. 

Furthermore, many patients do not respond to diuretics, and about half of patients are discharged with persistent congestion. This can result in patients returning to the hospital soon after discharge and being readmitted for further heart failure therapy.

Dapagliflozin is a sodium-glucose cotransporter 2 inhibitor that acts on the kidneys to increase the removal of sodium and glucose from the body. In April 2020, VUMC began a randomized, clinical trial of the drug in patients hospitalized with acute heart failure.

Research Execution Amidst Challenges

The study was designed by Vanderbilt University Medical Center’s JoAnn Lindenfeld, MD, and Sean Collins, MD, MSc, and by Cox, a member of Vanderbilt University Medical Center’s heart failure research team.

Despite the COVID-19 pandemic, which reached its crescendo in the middle of the study, the researchers were able to enroll 240 patients and complete the trial. Patients were enrolled at five sites: Vanderbilt University Medical Center, TriStar Centennial Medical Center and Ascension St. Thomas Hospital West in Nashville, the University of North Carolina at Chapel Hill, the University of Mississippi Medical Center in Jackson, and INTEGRIS Health Baptist Medical Center in Oklahoma City.

Within 24 hours of admission for acute heart failure, patients were randomized to receive either dapagliflozin or conventional diuretic treatment.

Promising Outcomes in Early Treatment Trials

While early administration of dapagliflozin did not improve weight-based diuretic efficiency compared to conventional treatment, patients who received the drug experienced no increase in adverse events, required shorter periods of IV diuresis, and were discharged faster during the five-day study period.

The trial demonstrated the safety and efficacy of starting a drug during early hospitalization that will continue to be prescribed upon discharge to help achieve optimal outpatient therapy and reduce the likelihood of readmission.

“It is a way to both improve diuresis and get a head start on implementing Guideline Directed Medical Therapy in patients with acute heart failure,” Lindenfeld says in a release.

The study was an investigator-initiated trial funded by AstraZeneca but independently conducted by Vanderbilt University Medical Center investigators. Dapagliflozin is marketed under the brand name FARXIGA. Acute heart failure research at Vanderbilt University Medical Center is supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Photo 30888065 © Spotmatik | Dreamstime.com