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Any form of heart disease, if progressive, will lead to the heart gradually failing in its role as an effective pump. This condition is called heart failure and it is typified by an impairment in quality of life and a substantial reduction in lifespan for the sufferer.

The good news Is that we now have some very good medications which can substantially improve prognosis in such patients. These include ACE inhibitors (eg Ramipiril), beta blockers (eg bisoprolol) and mineralocorticoid receptor antagonists (eg spironolactone). A combination of all 3 works even better than each individual agent. More recently there is a wonderful new agent called Entresto which is now being used in patients with severe heart failure and has also been shown to improve prognosis. Nevertheless despite all these agents, the prognosis in patients with bad heart failure is still poor and therefore researchers are always on the look out for new agents that could make a difference.

This is where this new agent that I am going to talk about comes in. The agent is called DAPAGLIFLOZIN. This agent which I will refer to as DAPA is actually an anti-diabetic agent which is used in patients with type 2 diabetes and it reduces blood sugar levels by increasing the amount of glucose that is passed out in the urine. It is known as an SGLT-2 (sodium-glucose co-transporter 2) inhibitor.

Very recently the results of a ground-breaking study called DAPA-HF have been published which have shown that this agent may also have a very beneficial impact in patients with heart failure.

In this study, 4744 patients with heart failure (ejection fraction of less than 40%) were randomised to either placebo or DAPA. The patients were on optimal heart failure medications (with the exception of Entresto which is still in its infancy in terms of widespread usage). 

The results were incredible. Patients who were given DAPA had significantly less cardiovascular death, hospitalisations for heart failure and better quality of life scores. The most interesting fact was that this benefit was observed in heart failure patients regardless of whether they had diabetes or not. There were also no really major or concerning adverse events in the patients who were taking DAPA.

The reason I wanted to do this video was that this is fairly groundbreaking research. The problem is that it will not be adopted in days to day practice for several years whilst it waits to be endorsed in clinical guidelines buy organisations such as NICE and in the meanwhile there may be patients out there who could significantly benefit but are not being prescribed the agent. I believe an educated patient is an empowered patient and therefore if you have heart failure or know someone who does then please share this with them so that they can be proactive and have an educated discussion with their doctors to see if they would be eligible for this agent.

I hope you found this useful.

Tags: DAPA; Dapagliflozin; DAPA-HF; heart failure; congestive heart failure; cardiomyopathy

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