#285 Should a ‘flozin be chosen to play a part for a failing heart?
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- DAPA-HF:1 4744 patients, dapagliflozin 10mg daily.
- At 18 months:
- Mortality: 11.6% versus 13.9% (placebo), number needed to treat (NNT)=44.
- Heart failure hospitalization: 9.7% versus 13.4% (placebo), NNT=27.
- At 8 months:
- 58.3% versus 50.9% (placebo) achieved minimal important improvement in quality of life (≥5 points on 100-point scale), NNT=14.
- Adverse events: No difference.
- At 18 months:
- EMPEROR-Reduced:2 3730 patients, empagliflozin 10mg daily. At 16 months:
- Mortality: 13.4% versus 14.2% (placebo), not statistically different.
- Heart failure hospitalization: 13.2% versus 18.3% (placebo), NNT=20.
- Adverse events:
- Genital infections: 1.7% versus 0.6% (placebo), NNH=91.
- One meta-analysis4 including both trials:
- Reduction in mortality (NNT=61) and heart failure hospitalization (NNT=24).
- Similar efficacy in those with or without diabetes, and with or without sacubitril-valsartan.
- SGLT2i efficacy comparable to other heart failure medications:5,6
- Mortality: Relative risk reduction ~13% (others ~16-35%).
- Heart failure hospitalization: Relative risk reduction ~30% (others ~20-35%).
- Unlike other heart failure medications, SGLT2i do not seem to cause significant hypotension or electrolyte abnormalities.1,2,4
- Canadian guidelines7 recommend SGLT2i for patients with “mild to moderate” heart failure, though sequence not specified (e.g. whether to consider SGLT2i prior to sacubitril-valsartan).
- Splitting empagliflozin 25mg in half=12.5 mg (trial dose=10 mg) cuts cost in half (to ~$560/year).8