The following is a summary of “Efficacy and Safety of Dapagliflozin in Patients With Acute Heart Failure,” published in the April 2024 issue of Cardiology by Cox et al.

The primary goal during acute heart failure (AHF) hospitalization is to clear out the congestion and optimize guideline-directed medical therapy (GDMT). While drugs like diuretics and others help with this, starting dapagliflozin early could tackle both of these goals at once.

Researchers conducted a prospective study verifying the efficacy of diuretics and the safety of dapagliflozin when given early in AHF. 

They enrolled 240 patients with hypervolemic AHF, giving them either 10 mg dapagliflozin once a day or standard care protocolized diuretic titration until day 5 or hospital discharge. The primary outcome was diuretic efficiency expressed as cumulative weight change per loop diuretic dose, and the secondary outcome was safety outcomes between the groups.

The results showed that dapagliflozin was not different from usual care (OR 0.65, 95% CI; 0.41-1.02, P=0.06). However, dapagliflozin meant lower loop diuretic doses (560 mg [Q1-Q3: 260-1,150 mg] vs 800mg [Q1-Q3: 380-1,715 mg], P=0.006) and fewer diuretics up-titrations (P≤0.05) to lose the same weight. With early dapagliflozin, no increase in safety issues was seen. However, dapagliflozin led to better 24-hour natriuresis (P = 0.03) and urine output (P = 0.005), speeding up hospital discharge.

Investigators concluded that early dapagliflozin in AHF hospitalization did not significantly reduce weight-based diuretic efficiency but did show signs of improving diuresis in patients with AHF. 

Source: jacc.org/doi/10.1016/j.jacc.2024.02.009