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Dapagliflozin in Black and White Patients With Heart Failure Across the Ejection Fraction Spectrum
Jawad H Butt1, Kieran F Docherty2, Brian L Claggett3
1British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Insights
Black patients with heart failure experienced greater absolute benefits from dapagliflozin treatment compared to White patients. This heart failure medication showed consistent relative benefits across both racial groups.
Area of Science:
- Cardiology
- Pharmacology
- Health Disparities
Background:
- Black individuals exhibit higher heart failure (HF) incidence, prevalence, and potentially worse outcomes than White individuals.
- Evidence suggests differential responses to HF pharmacotherapies between Black and White patients.
Purpose of the Study:
- To analyze treatment outcomes and response to dapagliflozin in Black versus White patients with heart failure with reduced, mildly reduced, or preserved ejection fraction.
- Pooled analysis of DAPA-HF and DELIVER trials to compare dapagliflozin efficacy across racial groups.
Main Methods:
- Compared outcomes in Black and White patients with heart failure receiving dapagliflozin versus placebo.
- Primary outcome: composite of worsening HF or cardiovascular death.
- Analysis focused on patients randomized in the Americas, with White patients serving as the comparator group for Black patients.
Main Results:
- The primary outcome occurred more frequently in Black patients (16.8 per 100 person-years) than White patients (11.6 per 100 person-years).
- Dapagliflozin similarly reduced the primary endpoint risk in both Black (HR: 0.69) and White patients (HR: 0.73), with no significant interaction.
- Absolute benefits of dapagliflozin were greater in Black patients (NNT: 12) compared to White patients (NNT: 17).
Conclusions:
- Dapagliflozin demonstrated consistent relative benefits for Black and White patients with heart failure across ejection fraction ranges.
- Absolute benefits of dapagliflozin were greater in Black patients, highlighting its efficacy in this population.
- The favorable safety profile and efficacy of dapagliflozin were confirmed in both racial groups.
Background:
Black people have a higher incidence and prevalence of heart failure (HF) than White people, and once HF has developed, they may have worse outcomes. There is also evidence that the response to several pharmacologic therapies may differ between Black and White patients.
Objectives:
The authors sought to examine the outcomes and response to treatment with dapagliflozin according to Black or White race in a pooled analysis of 2 trials comparing dapagliflozin to placebo in patients with heart failure with reduced ejection fraction (DAPA-HF [Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure]) and heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction (DELIVER [Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure]).
Methods:
Because most self-identified Black patients were enrolled in the Americas, the comparator group was White patients randomized in the same regions. The primary outcome was the composite of worsening HF or cardiovascular death.
Results:
Of the 3,526 patients randomized in the Americas, 2,626 (74.5%) identified as White and 381 (10.8%) as Black. The primary outcome occurred at a rate of 16.8 (95% CI: 13.8-20.4) in Black patients compared with 11.6 (95% CI: 10.6-12.7) per 100 person-years in White patients (adjusted HR: 1.27; 95% CI: 1.01-1.59). Compared with placebo, dapagliflozin decreased the risk of the primary endpoint to the same extent in Black (HR: 0.69; 95% CI: 0.47-1.02) and White patients (HR: 0.73 [95% CI: 0.61-0.88]; Pinteraction = 0.73). The number of patients needed to treat with dapagliflozin to prevent one event over the median follow-up was 17 in White and 12 in Black patients. The beneficial effects and favorable safety profile of dapagliflozin were consistent across the range of left ventricular ejection fractions in both Black and White patients.
Conclusions:
The relative benefits of dapagliflozin were consistent in Black and White patients across the range of left ventricular ejection fraction, with greater absolute benefits in Black patients. (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure [DAPA-HF]; NCT03036124; Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
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