*For medical professionals only
“img class=”content ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >Frailty is a syndrome associated with aging and comorbidities that can lead to falls, disability, dependence and premature death. Frail patients have several times the burden of healthcare services compared to non-frail patients.
The association between frailty and heart failure (HF) has been of concern because the two often coexist and one condition tends to increase the likelihood of the other . Thus, HF patients are 6 times more likely to develop frailty than the general population, and frail patients also have a higher risk of HF. Frailty can be seen as both a cause and a consequence of HF. Reducing the risk of developing frailty, slowing progression, and even reversing frailty are currently recognized goals in the overall management of HF.
The impact of new HF therapies on frail patients has also received widespread attention, mainly because: (1) frailty may alter some treatments (such as cardiac resynchronization) treatment) risk-benefit profile; (2) frail patients may be less tolerant and less compliant with treatment due to more relevant comorbidities, polypharmacy, and other factors; (3) because of concerns about efficacy and potential Because of concerns about adverse effects, clinicians may not be inclined to initiate new therapies in such patients.
In view of the above, it is extremely important to evaluate the efficacy and safety of novel therapies for HF with reduced ejection fraction (HFrEF) based on frailty.
Recently, the Annals of Internal Medicine published a post hoc analysis of the DAPA-HF (Dapagliflozin Prevention of Adverse Outcomes in Heart Failure) trial using Rockwood based on frailty status. The efficacy and safety of dapagliflozin were studied by the cumulative deficit method. Let’s take a look together!
Research Methods
One 3 A post hoc analysis of the randomized clinical trials of span>phases was performed in 20countries410 centers.
Inclusion criteria: patients with symptomatic heart failure (HF), left ventricular ejection fraction (LVEF) ≤ 40%, and patients with elevated natriuretic peptides.
Interventions: Add 10 mg/d dapagliflozin or placebo to the guideline-recommended treatment regimen (GDMT).
Primary endpoint: worsening of HF or cardiovascular death.
Results
Among 4744 patients randomized to DAPA-HF, Frailty Index (FI) could be calculated for 4742 patients:
2392 patients (50.4%) belonged to FI class 1 (FI≤0.210; not frail),
1606 (33.9%) belonged to FI level 2 (FI 0.211 to 0.310; weaker),
744 (15.7%) ) belonged to FI grade 3 (FI ≥ 0.311; most frail).
The median follow-up time was 18.2 months.
Dapagliflozin reduced the risk of worsening HF or cardiovascular death, regardless of FI grade.
Efficacy of dapagliflozin according to continuous FI
Dapagliflozin versus placebo,
from the lowest FI grade to the highest FI grade, per 100 person-years Differences in event rates were:
-3.5 (95% CI, -5.7 to -1.2),
-3.6 (95%CI, -6.6 to -0.5),
-7.9 (95%CI: -13.9 to -1.9).
Consistent benefits were observed in other clinical events and health conditions,
but in the most frail patients, absolute The decline is generally larger.
Regardless of the FI grade, the rates of discontinuation and serious adverse events of dapagliflozin were not higher than those of placebo.
According to FI, DargerMean Change in Individual Physical and Social Activity Items from Baseline to 8 Months for Liequin vs Placebo
< span>
A limitation of this study is that the inclusion criteria did not include very high-risk patients.
Study Conclusions
Irrespective of frailty status, reaching Glibin improved all test results.
However, the absolute reduction in clinical events was greater in more frail patients.
Source:
Efficacy and Safety of Dapagliflozin According to to Frailty in Heart Failure With Reduced Ejection Fraction : A Post Hoc Analysis of the DAPA-HF Trial. Ann Intern Med. 2022 Apr 26. doi: 10.7326/M21-4776.
p>
Recommended reading
Focusing on the latest progress in the mechanism, diagnosis and treatment of HFpEF, and looking forward to the management of HFpEF The future direction of development
Original in China | The efficacy and techniques of ablation of idiopathic premature atrial contractions
Perspectives | “Boundary” controversy between heart failure phenotypes
< p>Progress| In patients with anterior myocardial infarction, whether rivaroxaban can be used to prevent left ventricular thrombus
Progress| Clinical prognosis of 15 mg edoxaban in elderly patients with atrial fibrillation
< p>Progress | Defibrillator-free CRT, what is the impact on cardiovascular morbidity and mortality?
Progress | HFrEF patients, how to speed up drug titration and personalized therapy
Progress | The effects of diabetes, ethnicity and omega-3 fatty acids on the incidence of heart failure hospitalization
< p>Progress| 10-year long-term prognosis in survivors of acute myocardial infarction
Progress| JAMA: Echocardiographic measurements of left atrial function and dimensions are associated with dementia risk
Progress| Circulation Study: Impact of Type 2 Myocardial Infarction on Coronary Artery and Other Cardiac Diseases
Progress| How to develop acute heart failure prevention strategies? Regional differences in the causes of hospitalization for acute heart failure may be the answer
progress| discontinuation, platelet reactivity, and adverse outcomes of dual-antibody therapy after successful PCI
cases | tranexamic acid use In ACEI-induced angioedema