Results of the DICTATE-AHF randomized trial that tested starting dapagliflozin for patients hospitalized with acute heart failure confirmed the safety and benefit of this guideline-directed strategy.
included 238 adults who were within 24 hours of first presenting to any of six participating US hospitals with hypervolemic acute heart failure. All patients underwent a standard treatment protocol with IV loop diuretics, and half received additional, open-label treatment with a daily 10-mg dose of dapagliflozin., and about half had a left ventricular ejection fraction of 40% or less.
Both treatment arms experienced nearly identical weight loss, but for the people who received dapagliflozin, this occurred with a lower cumulative dose of diuretics. The diuretic efficiency with dapagliflozin produced comparable weight loss with a 35% lower amount of loop diuretic dose, a difference that fell just short of significance .
However, treatment with dapagliflozin also significantly boosted 24-hour natriuresis and 24-hour diuresis, and it significantly shortened the time to stopping treatment with IV diuretics and to hospital discharge, Cox reported. Dapagliflozin initiation and ongoing treatment was also safe and well tolerated compared with usual care.
The fact that the primary endpoint fell short of significance was"largely related" to the study's relatively small size, Wiviott suggested. He noted that thestudy, which is a much larger and potentially more definitive study of the safety and efficacy of dapagliflozin in comparison with usual care for patients with acute heart failure, is in progress. The study includes about 2400 patients.
The primary outcome is the combined rate of cardiovascular death or worsening heart failure during the 2 months following randomization. Results are expected in 2024.has received research funding from AstraZeneca and has been a consultant to Roche and Translational catalyst. Wiviott has received research funding from AstraZeneca and from Merck and has been a consultant to Icon Clinical and Novo
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