Dapagliflozin and days of full health lost through death, hospitalization, and impaired well-being in DAPA-HF

Abstract

Background: Conventional time-to-first-event analyses cannot incorporate recurrent hospitalizations and patient well-being in a single outcome.

Objectives: To overcome this limitation, we tested an integrated measure that includes days lost from death and hospitalization, and additional days of full health lost through diminished well-being.

Methods: The effect of dapagliflozin on this integrated measure was assessed in the DAPA-HF trial, which examined the efficacy of dapagliflozin, compared with placebo, in patients with NYHA class II-IV HF and a LVEF ≤40%.

Results: Over 360 days, patients in the dapagliflozin group (n=2,127) lost 10.6±1.0 [mean±SE] (2.9%) of potential follow-up days through cardiovascular death and HF hospitalization, compared with 14.4±1.0 days (4.0%) in the placebo group (n=2,108), and this component of all measures of days lost accounted for the greatest between-treatment difference [-3.8 (95%CI -6.6 to -1.0) days]. Patients receiving dapagliflozin also had fewer days lost to death and hospitalization from all causes, versus placebo [15.5±1.1 days (4.3%) vs. 20.3±1.1 days (5.6%)]. When additional days of full health lost (i.e., adjusted for KCCQ-OSS) were added, total days lost were 110.6±1.6 (30.7%) with dapagliflozin vs.116.9±1.6 days (32.5%) with placebo]. The difference in all measures between the two groups increased over time; i.e., days lost by death and hospitalization -0.9 days (-0.7%) at 120 days, -2.3 days (-1.0%) at 240 days, and -4.8 days (-1.3%) at 360 days.

Conclusions: Dapagliflozin reduced the total days of potential full health lost due to death, hospitalizations, and impaired well-being, and this benefit increased over time during the first year.

Keywords: dapagliflozin; health-related quality of life; heart failure; prognosis; trial.