Dapagliflozin: A Potential Aid in Acute Heart Failure

Dapagliflozin, a medication prescribed for managing Type 2 diabetes, has demonstrated additional benefits in heart failure conditions. This drug lowers the likelihood of hospitalization due to heart failure and mortality in individuals with complex health conditions such as heart and chronic kidney disease, as well as increased cardiovascular risk (1^✔ ✔Trusted Source
Efficacy and Safety of Dapagliflozin in Patients With Acute Heart Failure

Go to source). A collaborative multicenter study conducted by Vanderbilt University Medical Center (VUMC) and Lipscomb University College of Pharmacy in Nashville has discovered a promising novel therapy for acute heart failure. This condition is one of the major reasons for hospital admissions and mortality rates.

The researchers have reported that dapagliflozin can be beneficial for patients who have been admitted to the hospital due to acute heart failure. This medication enhances diuresis and eases congestion by removing surplus fluid from the lungs, consequently easing congestion, and has the potential to decrease the length of hospital stays. This study has been reported in the April 2024 issue of the Journal of the American College of Cardiology.

The first author of the article, Zachary Cox, PharmD, professor of Pharmacy Practice at Lipscomb University mentioned, “We demonstrated safety and efficacy of initiating dapagliflozin within the first day of hospitalization for acute heart failure,”.

Cox further added, “This will have international impact on the treatment of acute heart failure.”

What is Acute Heart Failure and What Has been its Conventional Therapy?

Acute heart failure is a critical condition in which the heart is unable to adequately pump blood to fulfil the body's requirements. It is also called acute decompensated heart failure (ADHF). This can lead to manifestations such as breathlessness, leg swelling, tiredness, and fast or irregular heart rhythms. Urgent medical care is required in these cases.

Every year, 800,000 individuals suffering from acute heart failure are hospitalized in the United States after seeking care in emergency rooms. These patients face a heightened risk of extended hospitalization and mortality. The cost of treating acute heart failure in the U.S. is estimated to surpass $34 billion annually.

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Diuretics are commonly prescribed to patients experiencing acute heart failure to alleviate symptoms and reduce lung congestion resulting from fluid accumulation. Nevertheless, the most effective strategy for administering diuretic therapy to patients admitted for acute heart failure is still unclear, leading to extended hospital stays and elevated rates of mortality and readmission.

Moreover, a considerable portion of patients fail to react positively to diuretics, and nearly half of them are sent home with ongoing congestion. As a result, these individuals may find themselves back in the hospital shortly after discharge, requiring a re-admission for additional heart failure management.

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Details of the Multicenter Study and How it Helps AHF

Dapagliflozin, an SGLT2 (sodium-glucose cotransporter 2) inhibitor, functions by enhancing the elimination of sodium and glucose from the kidneys. Vanderbilt University Medical Center (VUMC) initiated the randomized clinical trial in April 2020, involving this medication for patients admitted with acute heart failure.

VUMC’s team of Dr. JoAnn Lindenfeld and Dr. Sean Collins planned the study along with Cox, a member of the heart failure research team.

Cox said, “This unique partnership allows VUMC to conduct trials in acute heart failure that are only possible in a small number of medical centers across the world,”.

Patients were registered at five facilities other than VUMC: TriStar Centennial Medical Center and Ascension St. Thomas Hospital West in Nashville, the University of North Carolina at Chapel Hill, the University of Mississippi Medical Center in Jackson, and INTEGRIS Health Baptist Medical Center in Oklahoma City.

Patients who were admitted for acute heart failure were randomly assigned to receive either dapagliflozin or conventional diuretic treatment within 24 hours.

During the five-day study period, it was found that although early administration of dapagliflozin did not enhance the weight-based diuretic efficiency when compared to conventional treatment, patients who received the drug did not experience any increase in adverse events. Furthermore, they required shorter periods of IV diuresis and were discharged faster.

This trial effectively showcased the safety and effectiveness of initiating the drug during early hospitalization, which can then be continued upon discharge to aid in achieving optimal outpatient therapy and minimizing the chances of readmission.

Lindenfeld said, “It is a way to both improve diuresis AND get a head start on implementing Guideline Directed Medical Therapy in patients with acute heart failure,”.

This drug is a valuable addition to the available treatment options for patients experiencing acute heart failure.

Reference:

1. Efficacy and Safety of Dapagliflozin in Patients With Acute Heart Failure - (https://pubmed.ncbi.nlm.nih.gov/38569758/)

Source-Eurekalert