# Dapagliflozin vs empagliflozin in patients with chronic heart failure: a registry analysis

## TL;DR

This study compared dapagliflozin and empagliflozin in heart failure patients and found dapagliflozin linked to worse outcomes.

## Contribution

Registry analysis comparing real-world efficacy of two SGLT2 inhibitors in chronic heart failure patients.

## Key findings

- Dapagliflozin was associated with higher risk of death or cardiac events compared to empagliflozin.
- Patients on dapagliflozin showed worse NYHA functional class at 6 months.
- Results suggest a need for a direct randomized trial to confirm these findings.

## Abstract

To assess the relative efficacy of dapagliflozin and empagliflozin in routinely treated chronic heart failure (CHF) patients.

Data from a registry of prevalent and incident CHF patients were used to set up cohorts (new-user design) of patients started on dapagliflozin or empagliflozin in addition to other guideline-directed therapy. Cohorts were mutually balanced on a range of characteristics, and were assessed for the incidence of a composite of all-cause death/major adverse cardiac events (primary outcome) over the initial 6 months of treatment, and for New York Heart Association (NYHA) functional class at 6 months (secondary outcome). Frequentist and Bayes estimates were generated for the dapagliflozin vs empagliflozin comparison.

In both prevalent (dapagliflozin n = 393, empagliflozin n = 328) and incident (dapagliflozin n = 124, empagliflozin n = 116) patients, those prescribed dapagliflozin had somewhat higher incidence of the primary outcome, but the confidence intervals were wide (RR = 1.385, 95%CI 0.882-2.173 [prevalent], RR = 2.192, 95%CI 0.765-6.282 [incident]), and were more likely to present with a worse NYHA class at 6 months (OR = 1.552, 95%CI 1.142-2.108 [prevalent], OR = 1.503, 95%CI 0.844-2.676 [incident]). In the pooled data, primary events (n = 102) were more common in dapagliflozin-prescribed patients (frequentist estimate RR = 1.519, 95%CI 1.239-1.861; Bayes RR = 1.380, 95%CrI 0.981-1.944). Dapagliflozin-prescribed patients were also more likely to have a worse NYHA class at 6 months (OR = 1.540, 95%CI 1.208-1.962; Bayes OR = 1.425, 95%CrI 1.098-1.781).

CHF patients prescribed with dapagliflozin had poorer outcomes than their empagliflozin-prescribed peers over the initial 6 months of treatment. Data emphasize a need for a direct randomized comparison of the two treatments in this setting.