On 30 March, at this year’s American College of Cardiology (ACC) Scientific Session, during a poster contributions session on the topic of “Heart Failure and Cardiomyopathies”, David Savage-Lobeck, MD, presented a pooled analysis on the efficacy and safety of dapagliflozin in acute heart failure (HF).
The analysis presented at ACC supports that in-hospital initiation of dapagliflozin appears to accelerate decongestion and reduce adverse HF events, while preserving a reassuring safety profile. The pooled dataset includes more than 3,500 patients and draws on major trials, which strengthens confidence that the signal is not limited to one study population. Mechanistic analyses add weight by suggesting benefits beyond fluid removal, including improvement in coronary microvascular dysfunction and local cardiac inflammation. The analysis supports making dapagliflozin part of standard inpatient HF pathways rather than postponing it until discharge. If clinicians can initiate therapy safely during the acute phase, this could reduce therapeutic inertia, improve uptake, and help close the gap between trial efficacy and real-world care.
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The pooled analysis combined data from DAPA-ACT HF-TIMI 68, EMPULSE, and SOLOIST-WHF, to assess early treatment effects on cardiovascular outcomes, worsening heart failure, and all-cause mortality. The pooled analysis also includes a mechanistic component using data from studies of coronary microvascular disease, drawing on the DAPAHEART 4-year follow-up and the DAPA-VOLVO trial protocol to examine coronary flow reserve, microvascular function, and vascular inflammation. This analysis strengthens dapagliflozin’s positioning as a sodium-glucose transport 2 (SGLT2) inhibitor with the most comprehensive evidence across the HF continuum, from admission to long‑term management.
The incidence of acute HF is rising, representing a huge financial burden on global healthcare systems due to the resources and costs associated with hospitalisation and the highly likely readmission of a patient. A key opinion leader interviewed by GlobalData states: “Among elderly patients, the rehospitalisation rate is getting higher. Generally, a single patient will be hospitalised more than one time. I expect [the] total hospitalised patients’ number to more than double in the future.”
