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Estimated Long-Term Benefit of Dapagliflozin in Patients With Heart Failure.
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Vaduganathan, Muthiah (author)
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Claggett, Brian L. (author)
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Jhund, Pardeep (author)
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de Boer, Rudolf A. (author)
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Hernandez, Adrian F. (author)
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Inzucchi, Silvio E. (author)
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Kosiborod, Mikhail N. (author)
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Lam, Carolyn S. P. (author)
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Martinez, Felipe (author)
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Shah, Sanjiv J. (author)
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Desai, Akshay S. (author)
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Lindholm, Daniel (author)
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Petersson, Magnus (author)
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Langkilde, Anna Maria (author)
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McMurray, John J. V. (author)
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Solomon, Scott D. (author)
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- Elsevier BV, 2022
- English.
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In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 80:19, s. 1775-1784
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- BACKGROUND: Recent guidelines support consideration of sodium-glucose cotransporter-2 inhibitors in the long-term management of heart failure (HF) with mildly reduced or preserved ejection fraction. Patients and clinicians may be interested in the expected lifetime benefits of sodium- glucose cotransporter-2 inhibitors in this population. OBJECTIVES: This study aimed to estimate event-free survival gains from long-term use of dapagliflozin in patients with HF with mildly reduced or preserved ejection fraction overall and in clinically relevant subgroups. METHODS: In this prespecified analysis of DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we applied validated nonparametric age-based methods to extrapolate potential gains in survival free from the primary endpoint (cardiovascular death or worsening HF event) from long-term use of dapagliflozin. Eligible participants had symptomatic HF, left ventricular ejection fraction $>$40%, elevated natriuretic peptide levels, and structural heart disease. For every year between the ages of 55 and 85 years, we estimated event-free survival using age at randomization rather than time from randomization as the time horizon. Residual lifespan free from a primary endpoint was estimated based on area under the survival curve in each arm. RESULTS: Among 6,263 participants, mean survival free from the primary endpoint for a 65-year-old participant was 12.1 years (95% CI: 11.0-13.2 years) with dapagliflozin and 9.7 years (95% CI: 8.8-10.7 years) with placebo, representing a 2.3-year (95% CI: 0.9-3.8 years) event-free survival gain (P = 0.002). Treatment gains in survival free from the primary endpoint ranged from 2.0 years (95% CI: -0.6 to 4.6 years) in a 55-year-old to 1.2 years (95% CI: -0.1 to 2.4 years) in a 75-year-old patient. Mean event-free survival was greater with dapagliflozin than with placebo across all 14 subgroups. CONCLUSIONS: Treatment with dapagliflozin is projected to extend event-free survival by up to 2.0 to 2.5 years among middle-aged and older individuals with HF with mildly reduced or preserved ejection fraction. (DELIVER [Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure]; NCT03619213).
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- *Diabetes Mellitus
- Type 2/drug therapy
- *Heart Failure
- *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
- Aged
- Aged
- 80 and over
- Glucose
- heart failure with mildly reduced ejection fraction
- heart failure with preserved ejection fraction
- Humans
- implementation science
- Middle Aged
- modeling
- Sodium
- sodium-glucose cotransporter-2 inhibitors
- Stroke Volume
- Ventricular Function
- Left
Publication and Content Type
- ref (subject category)
- art (subject category)
To the university's database
- By the author/editor
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Vaduganathan, Mu ...
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Claggett, Brian ...
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Jhund, Pardeep
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de Boer, Rudolf ...
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Hernandez, Adria ...
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Inzucchi, Silvio ...
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show more...
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Kosiborod, Mikha ...
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Lam, Carolyn S. ...
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Martinez, Felipe
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Shah, Sanjiv J.
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Desai, Akshay S.
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Lindholm, Daniel
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Petersson, Magnu ...
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Langkilde, Anna ...
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McMurray, John J ...
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Solomon, Scott D ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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Journal of the A ...
- By the university
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Uppsala University