Effects of Dapagliflozin on Hypotensive Patients With Depressed Left Ventricular Ejection Fraction After Sacubitril/Valsartan Therapy
Overview
- Phase
- Phase 4
- Intervention
- Dapagliflozin
- Conditions
- Hypotension
- Sponsor
- Cheng-Hsin General Hospital
- Enrollment
- 78
- Locations
- 1
- Primary Endpoint
- 6-minute walking distance
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
The DAPA-HF trial demonstrated that dapagliflozin was able to reduce the risk of worsening heart failure events and cardiovascular death comparing to placebo in patients with reduced ejection fraction further to standard of care. However, hypotensive patients who generally have higher risks comparing to normotensive patients, were under represented in the DAPA-HF. The investigators aimed to evaluate clinical effects of dapagliflozin on hypotensive heart failure patients receiving chronic sacubitril/valsartan treatment.
Detailed Description
The DAPA-HF trial demonstrated that dapagliflozin was able to reduce the risk of worsening heart failure (HF) events and cardiovascular death comparing to placebo in patients with reduced ejection fraction further to standard of care. However, hypotensive patients who generally have higher risks comparing to normotensive patients, were under represented in the DAPA-HF. The investigators aimed to evaluate clinical effects of dapagliflozin on hypotensive HFrEF patients receiving chronic sacubitril/valsartan (Sal/Val) treatment. This is an investigator-initiated, interventional, prospective. open-label study. The inclusion criteria were (1) chronic symptomatic HF with New York Heart Association (NYHA) class II-IV and LVEF less than 40%, (2) treatment with stable and maximal tolerable dose of Sac/Val, beta-blocker with or without mineralocorticoid receptor antagonist (MRA), (3) 6-minute walking-distance (6MWD)≥ 100meters and ≤425 meters at enrollment, (4) systolic blood pressure ≤100 mmHg at enrollment. The exclusion criteria were (1) type 1 diabetes mellitus, (2) patients previously treated with any sodium glucose co-transporter 2 inhibitor (SGLT2i). After applying the inclusion and exclusion criteria, if the participants had type 2 diabetes mellitus, the participants will receive dapagliflozin 10mg daily directly. If the participants did not have history of diabetes mellitus, the participants will be allocated to either receiving dapagliflozin 10mg daily or receiving standard heart failure treatment without dapagliflozin. Vital signs and laboratory tests were examined at baseline, 2-week, 4-week and 12-week. Six-minute-walking-test, five-level EuroQol five dimensions (EQ-5D-5L) questionnaire and visual analogue scale (VAS) were collected at baseline and at 12-week.
Investigators
Hung-Yu Chang
Attending Physician
Cheng-Hsin General Hospital
Eligibility Criteria
Inclusion Criteria
- •chronic symptomatic HF with New York Heart Association (NYHA) class II-IV and left ventricular ejection fraction (LVEF) less than 40%
- •treatment with stable and maximal tolerable dose of Sac/Val, beta-blocker with or without mineralocorticoid receptor antagonist
- •6-minute walking-distance (6MWD)≥ 100meters and ≤425 meters at enrollment
- •systolic blood pressure ≤100 mmHg at enrollment
Exclusion Criteria
- •hemodialysis
- •severe co-morbidities with life expectancy less than 1 year
- •type 1 diabetes mellitus
- •ever treated with any type of sodium glucose cotransporter 2 inhibitor (SGLT2i)
Arms & Interventions
Dapagliflozin
Dapagliflozin with standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Dapagliflozin
Dapagliflozin
Dapagliflozin with standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Sacubitril-Valsartan
Dapagliflozin
Dapagliflozin with standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Beta blocker
Dapagliflozin
Dapagliflozin with standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Mineralocorticoid Receptor Antagonist
Dapagliflozin
Dapagliflozin with standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Cardiac resynchronization therapy and/or implantable cardioverter defibrillator
Standard of care
Standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Sacubitril-Valsartan
Standard of care
Standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Beta blocker
Standard of care
Standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Mineralocorticoid Receptor Antagonist
Standard of care
Standard-of-care therapies for heart failure, including sacubitril/valsartan, beta-blocker, MRA, ICD and CRT
Intervention: Cardiac resynchronization therapy and/or implantable cardioverter defibrillator
Outcomes
Primary Outcomes
6-minute walking distance
Time Frame: 12 weeks
Measuring walking distance within 6 minutes
Secondary Outcomes
- EQ-5D-5L(12 weeks)
- EQ-Visual analogue scale (EQ-VAS)(12 weeks)