Dapagliflozin Shows Promising Results for Heart Failure Patients Post-TAVI

In a groundbreaking study presented at the American College of Cardiology (ACC) 2025 Annual Scientific Sessions, researchers revealed that daily administration of dapagliflozin significantly reduces the risk of mortality and worsening heart failure (HF) in patients who underwent transcatheter aortic valve implantation (TAVI). This finding comes from the DapaTAVI trial, which included over 1,200 patients in Spain, primarily elderly individuals with an average age of 82 and a majority being women.

Dr. Sergio Raposeiras-Roubin, a clinical cardiologist and professor at the University of Santiago de Compostela, emphasized the importance of SGLT2 inhibitors, like dapagliflozin, which have been largely overlooked in clinical trials involving valvular heart disease patients. "For those at risk of heart failure undergoing TAVI, it's crucial to consider treatment with dapagliflozin or another SGLT2 inhibitor," he stated, asserting the safety and effectiveness of these medications.

Currently, clinical guidelines from both the U.S. and Europe advocate for SGLT2 inhibitors to reduce HF-related hospitalizations, regardless of a patient’s left ventricular ejection fraction (LVEF) or diabetes status. However, past evidence has been scarce for patients experiencing heart failure due to reversible conditions such as aortic stenosis.

As TAVI patients are generally older, often above 80 years, Dr. Raposeiras-Roubin highlighted that this population is frequently excluded from trials focusing on SGLT2 inhibitors, resulting in less prescription activity among clinicians. The DapaTAVI study aimed to fill this gap by testing the efficacy and safety of a daily dose of 10 mg dapagliflozin among patients with severe aortic stenosis undergoing TAVI.

Participants in the study had a history of HF hospitalization and exhibited at least one high-risk condition, such as renal insufficiency, diabetes, or low LVEF. Of the patients enrolled, 620 were designated to receive dapagliflozin within two weeks following TAVI, while 637 were assigned to standard care, leading to a final analysis of 1,222 patients.

The results revealed that the primary endpoint—comprising all-cause mortality or worsened heart failure—was 28% lower among dapagliflozin recipients (15.0%) compared to those on standard care (20.1%); the hazard ratio was recorded at 0.72, indicating significant efficacy (P = .02). Notably, the study also found a 37% reduction in the incidence of worsening heart failure among those treated with dapagliflozin.

Additionally, although mortality differences between the two groups did not reach statistical significance, the incidence of worsening heart failure was notably lower in the dapagliflozin group (9.4% vs. 14.4% in standard care; subhazard ratio, 0.63; P < .05). Safety evaluations revealed no substantial variations in urinary tract infections; however, there was a higher incidence of genital infections and hypotension among dapagliflozin users.

Plans are underway to further analyze outcomes based on LVEF status and quality of life for this patient demographic. Dr. Raposeiras-Roubin remarked, “Our findings confirm the safety of these treatments even in older patients, rectifying previous gaps in clinical evidence.” He emphasized the importance of generating reliable data for those typically excluded from trials to inform better clinical practices in managing heart failure linked to aortic stenosis.

These promising results open a new chapter in the management of heart failure, especially in elderly patients, and reinforce the necessity of innovative treatments within cardiology. Stay tuned as further research unfolds, potentially transforming treatment options for millions grappling with heart failure!