medwireNews: A post-hoc analysis of the DAPA-HF trial indicates that dapagliflozin is beneficial in people with heart failure (HF) and reduced ejection fraction regardless of frailty, but with the largest gains in the frailest individuals.
“These findings are important considering the common reluctance of clinicians to introduce medications to patients that are perceived to be frail,” write John McMurray (University of Glasgow, UK) and co-investigators in the Annals of Internal Medicine.
Almost half of the 4742 DAPA-HF participants with available data were classed as frail according to a 32-item Frailty Index. These people were older than nonfrail people, with more cardiovascular comorbidities and more severe HF. They were also much more likely to have type 2 diabetes.
During follow-up, greater frailty was associated with a higher risk for worsening HF or cardiovascular death, but was also associated with larger treatment benefits. Specifically, the number needed to treat with dapagliflozin to prevent one event per 100 person–years was 31 for people who were not frail, 25 for those who were somewhat frail, and 15 for those who were very frail.
Frailer participants also had greater symptom improvements with dapagliflozin versus placebo on the Kansas City Cardiomyopathy Questionnaire.
“Improving HF-related health status may be as important as extending life, particularly in the most frail patients who have a greater symptom burden, more physical limitations, and worse quality of life than nonfrail patients,” comment the researchers.
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