Steven Coombs, Angela Tithecott, Cristina Thiebaud, Parminder Chaggar, Diane Barker, Prithwish Banerjee, Henry Oluwasefunmi Savage, Alastair Gray, Geraint Jenkins, Mohammad Albarjas, Liz Hennessy, Joanna De Courcy, Hannah Wallis, Thom Dewar, Reece Manuell, Sophie Barlow, Samuel Adamsson Eryd, Jil Billy Mamza, Tamsin Morris
Patients receiving dapagliflozin recorded low levels of discontinuation, suggesting high tolerability. Many patients do not receive all four recommended treatment pillars, highlighting an opportunity for further treatment optimization. Patients had fair-to-good QoL throughout the study, indicating good patient experience during HFrEF treatment including dapagliflozin.
BACKGROUND: Sodium-glucose cotransporter-2 inhibitor (SGLT2i) dapagliflozin has shown favourable outcomes in trials for heart failure with reduced ejection fraction (HFrEF), but little is known about real-world prescribing practices, tolerability, or impact on patient quality of life (QoL) in the United Kingdom.
METHODS: This study was an observational longitudinal cohort study of adult patients with HFrEF in the UK, following the date of first initiation of dapagliflozin. Baseline patient characteristics, concomitant medication prescribed at enrolment, and changes to these treatments were recorded at 3, 6, 9 and 12 months following initiation. Patients completed KCCQ-23, MARS-5 and WPAI patient-reported outcome measures to assess QoL, treatment adherence and work/activity impairment, respectively, at enrolment and follow-up.
RESULTS: N = 237 patients were enrolled, with n = 231 remaining at study end. Mean (95% confidence interval) age was 69.3 (67.8-70.8), 70.0% were male and 91.6% White. Mean time from HFrEF diagnosis to initiation of dapagliflozin was 20.9 (15.3-26.4) months. Dapagliflozin discontinuation rate was 11.7/100 patient-years, most commonly due to adverse drug reactions (65.0%). The majority of patients received four treatment pillars at enrolment and 12-months (54.4% and 58.4% respectively). At enrolment and 12 months, 33.8% and 30.5% respectively received three out of four pillars. Mean overall KCCQ-23 scores ranged from 67.6 (64.3-70.9) to 71.6 (67.3-74.9), and patients reported high levels of adherence, with MARS-5 scores of 23.1 (22.3-23.9) or above. Overall work impairment ranged from 31.2% (18.5-43.9%) at enrolment to 16.3% (7.4-25.2%) at 12 months, and overall activity impairment from 40.5% (36.3-44.7%) to 36.8% (32.1-41.5%).
CONCLUSIONS: Patients receiving dapagliflozin recorded low levels of discontinuation, suggesting high tolerability. Many patients do not receive all four recommended treatment pillars, highlighting an opportunity for further treatment optimization. Patients had fair-to-good QoL throughout the study, indicating good patient experience during HFrEF treatment including dapagliflozin.