Dapagliflozin After Transcatheter Aortic Valve Implantation According to Frailty in DapaTAVI Trial.
Rafael Gonzalez-Manzanares, Soledad Ojeda, Ignacio Amat-Santos et al.
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In 30 seconds
This post hoc analysis of the multicenter randomized DapaTAVI trial examined whether frailty modified dapagliflozin’s effects after transcatheter aortic valve implantation. Among 1222 patients with frailty assessed, 47.2% were frail. At 1 year, frailty was associated with higher risk of death or worsening heart failure, and dapagliflozin was associated with lower risk in frail patients (HR, 0.53 [95% CI, 0.36-0.77]), but not in prefrail or robust patients; the interaction P value was 0.021. Frailty did not appear to modify dapagliflozin’s safety profile.
Key findings
- At 1 year, 215 patients (17.6%) experienced all-cause death or worsening heart failure.
- Compared with robust patients, adjusted risk was higher in prefrail patients (HR, 1.88 [95% CI, 1.05-3.38]) and frail patients (HR, 2.29 [1.29-4.07]; P =0.004).
- Dapagliflozin was associated with lower primary-outcome risk in frail patients (HR, 0.53 [95% CI, 0.36-0.77]), but not in prefrail or robust patients (P for interaction=0.021).
- There was no evidence that frailty modified dapagliflozin’s safety profile.
Why it matters
Frailty identified patients at higher risk of death or worsening heart failure after valve implantation. The apparent variation in dapagliflozin’s relative benefit by frailty status may help inform interpretation of treatment effects in this population, while underscoring that frailty is relevant to risk assessment after the procedure.
What to keep in mind
This was a post hoc analysis, and the reported subgroup associations do not establish that dapagliflozin’s effect truly differs by frailty.