- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42(36):3599–726.
- Jackson AM, Rørth R, Liu J, et al. Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2022;24(3):497–509.
- Butler J, Packer M, Filippatos G, et al. Effect of empagliflozin in patients with heart failure across the spectrum of left ventricular ejection fraction. Eur Heart J 2022;43(5):416–26.
- Kondo T, McMurray JJV. Re-emergence of heart failure with a normal ejection fraction? Eur Heart J 2022;43(5):427–9.
- Solomon SD, de Boer RA, DeMets D, et al. Dapagliflozin in heart failure with preserved and mildly reduced ejection fraction: rationale and design of the DELIVER trial. Eur J Heart Fail 2021;23(7):1217–25.
- Solomon SDM McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089–98.
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016:18(8):891–975.
- Vaduganathan M, Docherty KF, Claggett B, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet 2022:400(10354):757–67.
- Kosiborod MN, Jhund PS, Docherty KF, et al. Effects of Dapagliflozin on Symptoms, Function, and Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction: Results From the DAPA-HF Trial. Circulation. 2020 ; 141(2) :90–9.
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Background
What do we already know about this topic?
- A clinical diagnosis of heart failure (HF) is made based on signs and symptoms and an echocardiogram is conducted (or some other measurement of ejection fraction [EF]).1
- Classification of HF based on EF:1
- A reduced EF (≤40%) was previously taken as an indication of HF.
- A group of patients with HF and an EF that is ≥50% (‘normal’) were termed ‘preserved EF HF patients’.
- Mid-range EF is now more commonly known as ‘mildly reduced’ EF of 41–49%.
- HF with preserved EF is under recognised in both diabetes and cardiology communities.
- Patients with both HF and diabetes are at much higher risk of hospitalisation and cardiovascular (CV) death than patients without diabetes.2–4
How was this study conducted?
- The DELIVER trial was a randomised, double-blind, placebo-controlled global trial aimed to assess the efficacy and safety of dapagliflozin (sodium-glucose cotransporter-2 [SGLT-2] inhibitor) across glycaemic categories in patients with HF with mildly reduced or preserved EF.5
- Patients were enrolled globally across 353 sites in 20 countries.5
- This study had a pre-specified analysis and patients were split into 3 groups:5
- Normoglycaemia (no history of diabetes and baseline HbA1c <5.7 [39 mmol/mol])
- Prediabetes (no history of diabetes and baseline HbA1c 5.7–<6.5% [39–<48 mmol/mol]).
- Type 2 diabetes (history of and/or prevalent use of a glucose lowering agent [unless specifically prescribed for an indication other than diabetes]) or baseline HbA1c ≥6.5 [48 mmol/mol]).
