Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA-HF

Pooja Dewan, Kieran F. Docherty, Olof Bengtsson, Rudolf A. de Boer, Akshay S. Desai, Jaroslaw Drozdz, Nathaniel M. Hawkins, Silvio E. Inzucchi, Masafumi Kitakaze, Lars Køber, Mikail N. Kosiborod, Anna Maria Langkilde, Daniel Lindholm, Felipe A. Martinez, Béla Merkely, Mark C. Petrie, Piotr Ponikowski, Marc S. Sabatine, Morten Schou, Mikaela SjöstrandScott D. Solomon, Subodh Verma, Pardeep S. Jhund, John J.V. McMurray*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Scopus)


Aims: Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure (HF) with reduced ejection fraction (HFrEF), associated with worse outcomes and often suboptimal treatment because of under-prescription of beta-blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. The aim of this study was to examine outcomes related to COPD in a post hoc analysis of the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial. Methods and results: We examined whether the effects of dapagliflozin in DAPA-HF were modified by COPD status. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. Overall, 585 (12.3%) of the 4744 patients randomized had a history of COPD. Patients with COPD were more likely to be older men with a history of smoking, worse renal function, and higher baseline N-terminal pro B-type natriuretic peptide, and less likely to be treated with a beta-blocker or mineralocorticoid receptor antagonist. The incidence of the primary outcome was higher in patients with COPD than in those without [18.9 (95% confidence interval 16.0–22.2) vs. 13.0 (12.1–14.0) per 100 person-years; hazard ratio (HR) for COPD vs. no COPD 1.44 (1.21–1.72); P < 0.001]. The effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with [HR 0.67 (95% confidence interval 0.48–0.93)] and without COPD [0.76 (0.65–0.87); interaction P-value 0.47]. Conclusions: In DAPA-HF, one in eight patients with HFrEF had concomitant COPD. Participants with COPD had a higher risk of the primary outcome. The benefit of dapagliflozin on all pre-specified outcomes was consistent in patients with and without COPD. Clinical Trial Registration: ClinicalTrials.gov ID NCT03036124.

Original languageEnglish
Pages (from-to)632-643
Number of pages12
JournalEuropean Journal of Heart Failure
Issue number4
Publication statusPublished - Apr 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.


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