New research was presented at ESC 2022, the annual European Society of Cardiology Congress. The features below highlight some of the studies that emerged from the conference.

Dapagliflozin DELIVERs for HFmrEF/HFpEF

The phase 3 DELIVER trial aimed to determine whether dapagliflozin would decrease cardiovascular morbidity and mortality in patients with HFmrEF/HFpEF. The double-blind, placebo-controlled trial randomized patients (N=6,263) with symptomatic HF with an ejection fraction greater than 40%—including 18% of the patients whose ejection fraction was previously 40% or lower—to either dapagliflozin 10 mg once daily or placebo. The primary endpoint was a composite of cardiovascular death or worsening HF. With a median follow-up of 2.3 years, primary
outcome events occurred in 16.4% of those in the dapagliflozin arm and 19.5% in the placebo group. The discontinuation rate was 14% in both arms, and 29% were lost to follow-up. Worsening HF occurred in 11.8% in the dapagliflozin group versus 14.5% in the placebo group. However, cardiovascular death was not different between the
arms, occurring in 7.4% and 8.3% of patients, respectively. Total HF hospitalizations, cardiovascular death, and total symptom burden also favored dapagliflozin.

Acetazolamide Plus Loop Diuretics Improve Decongestion

Patients with acute decompensated HF were randomized to receive standard loop diuretics with the addition of either acetazolamide (500 mg IV; N=259) or placebo (N=256) for the ADVOR study.  At randomization, oral loop diuretics were stopped and all participants received high-dose, IV loop diuretics. Participants had an average age of 78, an average ejection fraction of 43, and at least one clinical sign of volume overload (eg, ascites, pleural effusion, or edema), elevated natriuretic peptide levels, and had been taking oral diuretics for at least 1 month. Randomization was stratified according to the left ventricular ejection fraction (LVEF ≤40% or >40%).

The primary endpoint was met; 42.2% of participants in the acetazolamide group versus 30.5% in the placebo group were successfully decongested within 3 days, with a relative risk (RR) of 1.46. At discharge, 78.8% of the acetazolamide group versus 62.5% of the placebo group had successful decongestion (RR, 1.27). Patients in the acetazolamide arm had a shorter hospital length of stay (average, 8.8 days) compared with those in the placebo arm (average, 9.9 days). However, there were no differences between the arms in the composite outcome of all-cause mortality and hospitalization for HF within 3 months (HR, 1.07). Safety signals were not different between the arms, and the incidence rates of renal decline, hypokalaemia, hypotension, and adverse events were similar between the groups.