Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure

作者：David D. Berg, Siddharth M. Patel, Paul M. Haller, Abby L. Cange, Michael G. Palazzolo, Andrea Bellavia, Julia Kuder, Akshay S. Desai, Silvio E. Inzucchi, John J.V. McMurray, Eileen O’Meara, Subodh Verma, Jan Bělohlávek, Jarosław Dróżdż, Béla Merkely, Modele O. Ogunniyi, T. Drasnar, Joseph L. Izzo, Balázs Sármán, John McGinty, Krishnan Ramanathan, Angel Mulkay, Andrzej Przybylski, Christian T. Ruff, Michelle L. O’Donoghue, Sabina A. Murphy, Marc S. Sabatine, Stephen D. Wiviott · 发表于：Circulation · 年份：2025 · DOI：10.1161/circulationaha.125.076575 · 被引用次数：45 · 研究领域：Diabetes Treatment and Management、Hyperglycemia and glycemic control in critically ill and hospitalized patients、Pancreatic function and diabetes

BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors reduce the risk of cardiovascular death or worsening heart failure (HF) in outpatients with HF. Data on initiation in patients hospitalized for HF are limited. METHODS: We conducted a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of in-hospital initiation of dapagliflozin (10 mg daily) in patients hospitalized for HF. The primary efficacy outcome was a composite of time to cardiovascular death or worsening HF through 2 months. Key safety outcomes included symptomatic hypotension and worsening kidney function. A prespecified meta-analysis of randomized trials evaluating initiation of SGLT2 inhibitors in patients hospitalized for HF was performed. RESULTS: Of 2401 patients (median age, 69 [Q1–Q3, 58–77] years, 815 [33.9%] women, 448 [18.7%] Black race, 1717 [71.5%] left ventricular ejection fraction ≤40%, 1074 [44.7%] newly diagnosed HF) randomized between September 2020 and March 2025, 1218 were assigned to dapagliflozin and 1183 to placebo. The primary outcome occurred in 133 patients (10.9%) in the dapagliflozin group and 150 (12.7%) in the placebo group (hazard ratio [HR], 0.86 [95% CI, 0.68–1.08]; P =0.20). A worsening HF event occurred in 115 (9.4%) and 122 (10.3%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.91 [95% CI, 0.71–1.18]). Cardiovascular death occurred in 30 (2.5%) and 37 (3.1%) patients (HR, 0.78 [95% CI, 0.48–1.27]), and death from an...