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Canadian Perspectives on ESC 2022 – DELIVER Trial

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Foreign trial heart failure with preserved ejection fraction probably represents about half of all of our patients with a heart failure and is associated with a substantial morbidity and mortality there is a positive evidence-based therapies in patients with heft pef however the emperor preserved trial demonstrated reduction in cardiovascular death or heart filler

Hospitalization with amplifozan in this population uncertainty remains regarding the efficacy in several groups there’s been concern about attenuation of treatment affecting patients with efs above 60 percent there’s limited data with those initiated on treatment during or soon after hospitalization and those were the previously reduced ejection fraction that is

Improved to greater than 40 percent deliver was a randomized double-blind placebo-controlled trial testing the hypothesis that dapaglifosin would reduce cardiovascular death or worsening heart failure in patients with heart failure and a mildly reduced or preserved ejection fraction patients with an ejection reaction above 40 were randomized to dapper glyphosum

10 milligrams daily versus placebo patients had nyj class 2-4 symptoms and an ejection fraction over 40 percent patients who had a prior left reticular injection fraction less than 40 percent were included if ef improved to over 40 at the time of enrollment patients had to have evidence of structural heart disease evidenced by lvh or left atrial enlargement and

Elevated naturally peptides they can be enrolled either as ambulatory patients or during a hospitalization for heart failure the primary endpoint was time to first composite of the cardiovascular death or worsening heart failure secondary endpoints include a total heart failure events and cardiovascular death and total symptom score 6263 patients with a half pep

Or half meth were randomized 3131 patients were assigned to the topical frozen arm and 3132 patients were assigned to the placebo arm patients were followed for a medium of 2.3 years here are the baseline characteristics it was well balanced between the treatments mean age was 71 to 72 years but 44 were women and 45 percent had diabetes baseline ejection fraction

Was around 54 with 70 percent of patients having had an ef less than 60 percent 18 of the patients had a prior ejection fraction less than 40 percent about 40 of the patients at afib and about three quarters of the patients were nyj class 2. the anti-probium p levels were shown here in patients with atrial fibrillation and in those without atrial fibrillation the

Mean egfr was 61. when it comes to underlying medications about 77 of patients were on loop diuretics and over 80 on a beta blocker above 80 percent of patients run on racy or rna therapy about 40 percent of patients run a mineralocorticoid receptor antagonists which is the highest of heart failure trials in patients with mildly produced or preserved ejection

Fraction in terms of primary results there were 610 events in the placebo arm representing 9.6 per 100 patient years dapa glyphosis group had only 512 events representing a rate of 7.8 per 100 patient years this gives a hazard ratio of 0.82 a significant result with a p-value of .0008 the number needed to trade was 32. here you can see the pre-specified result

In the subpopulation of patients with an ejection fraction less than 60 percent this shows that there is virtually no difference in the ultimate result from these two groups looking at the components of the primary endpoint the majority of benefit seems to come from a worsening heart failure event which was reduced by 21 cardiovascular death was reduced by 12

But was non-significant primary endpoints and pre-specified groups here you can see there’s no heterogeneity based on ranges of the left ventricular ejection fraction the specifically there was no evidence of attenuation in the highest ejection fraction group there was similar benefit for patients enrolled within 30 days or during hospitalization there was

Similar benefit in patients with improved ejection fraction compared to consistently greater than 40 injection fraction there are numerous other pre-specified subgroups there are no outliers who did not get benefit but just to highlight a few the results were very similar regardless of diabetic status there was no difference among males or females or based on

Egfr above or below 60. in terms of secondary endpoint the first secondary point was total heartfelt events and cardiovascular death there was a reduction in not just the first hospitalization in cardiovascular death but ultimate recurrent events as you can see on the left yielding a rate ratio of 0.77 and a p-value of 0.003 the total symptom burden uses the kccq

Score showed the total symptom score from baseline to eight months was statistically better in patients receiving dapolosan for any cirrus adverse event any adverse event leading to a treatment discontinuation or treatment or disruption there is numerically fewer patients in the dapa group than in the placebo group there were very few numbers of amputations dka

Or major hypoglycemic events in summary deliver is the largest and most inclusive trial of patients with a heart failure and mildly reduced or preserved ejection fraction treatment with dapper glyphosine reduced the risk of the primary composite outcome of cardiovascular death or worsening heart failure by 18 with an nnt of 32. dapaglifosin was as effective in

Patients with recent hospitalization and in those with prior reduced ejection fractions that improved to over 40 percent these findings were consistent across pre-satified groups including those defined according to left ventricular ejection fraction with no attenuation in the highest ejection fraction group

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Canadian Perspectives on ESC 2022 – DELIVER Trial By Canadian Cardiovascular Society