Evidence map›Paper›PMID 37220172›Full record

SynthesisEuropean heart journal2023

Heart failure, peripheral artery disease, and dapagliflozin: a patient-level meta-analysis of DAPA-HF and DELIVER.

Jawad H Butt, Toru Kondo, Mingming Yang, Pardeep S Jhund, Kieran F Docherty, Muthiah Vaduganathan, Brian L Claggett, Adrian F Hernandez, Carolyn S P Lam, Silvio E Inzucchi and 13 more

Erratum issuedOpen access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 18 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 3 pooled it
6.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 34 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Review
  6. Article
  7. Sodium-glucose cotransporter 2 inhibitors and atherosclerosis.American journal of preventive cardiology · 2025
    Review
  8. Review
  9. Article
  10. Review
  11. Review
  12. New horizons in nuclear cardiology: Imaging of peripheral arterial disease.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2025
    Review
  13. Article
  14. Review
  15. Review
  16. Review
  17. Article
  18. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors at 12 institutions in 8 countries.

Jawad H ButtBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.ORCID 0000-0002-7380-4144
Toru KondoBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
Mingming YangBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
Pardeep S JhundBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
Kieran F DochertyBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
Muthiah VaduganathanCardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.ORCID 0000-0003-0885-1953
Brian L ClaggettCardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Adrian F HernandezDuke University Medical Center, Durham, NC, USA.
Carolyn S P LamNational Heart Centre Singapore, Singapore.ORCID 0000-0003-1903-0018
Silvio E InzucchiYale School of Medicine, New Haven, CT, USA.
Felipe A MartinezUniversity of Cordoba, Cordoba, Argentina.
Rudolf A de BoerErasmus Medical Center, Rotterdam, The Netherlands.
Mikhail N KosiborodSaint Luke's Mid America Heart Institute, Kansas City, MO, USA.
Akshay S DesaiCardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Lars KøberDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Piotr PonikowskiDepartment of Heart Disease, Wroclaw Medical University, Wroclaw, Poland.
Marc S SabatineTIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Sanjiv J ShahNorthwestern University Feinberg School of Medicine, Chicago, IL, USA.
Natalia ZaozerskaLate-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
Ulrica WilderängLate-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
Olof BengtssonLate-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.ORCID 0000-0003-1315-8176
Scott D SolomonCardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
John J V McMurrayBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.ORCID 0000-0002-6317-3975
Brigham and Women's Hospital · USBritish Heart Foundation · GBAstraZeneca (Sweden) · SECopenhagen University Hospital · DKDuke Medical Center · USErasmus MC · NLNagoya University · JPNational University of Singapore · SGNorthwestern University · USSaint Luke's Hospital · USWroclaw Medical University · PLYale University · US

Funding

British Heart Foundation RE/18/6/34217
6 · The paper itself

Abstract

aimsBecause an increased risk of amputation with canagliflozin was reported in the CANVAS trials, there has been a concern about the safety of sodium-glucose cotransporter 2 inhibitors in patients with peripheral artery disease (PAD) who are at higher risk of amputation. METHODS AND

resultsA patient-level pooled analysis of the DAPA-HF and DELIVER trials, which evaluated the efficacy and safety of dapagliflozin in patients with heart failure (HF) with reduced, mildly reduced/preserved ejection fraction, respectively, was conducted. In both trials, the primary outcome was the composite of worsening HF or cardiovascular death, and amputation was a prespecified safety outcome. Peripheral artery disease history was available for 11 005 of the total 11 007 patients. Peripheral artery disease was reported in 809 of the 11 005 patients (7.4%). Median follow-up was 22 months (interquartile range 17-30). The rate of the primary outcome (per 100 person-years) was higher in PAD patients than that in non-PAD patients: 15.1 [95% confidence interval (CI) 13.1-17.3) vs. 10.6 (10.2-11.1]; adjusted hazard ratio 1.23 (95% CI 1.06-1.43). The benefit of dapagliflozin on the primary outcome was consistent in patients with [hazard ratio 0.71 (95% CI 0.54-0.94)] and without PAD [0.80 (95% CI 0.73-0.88)] (Pinteraction = 0.39). Amputations, while more frequent in PAD patients, were not more common with dapagliflozin, compared with placebo, irrespective of PAD status (PAD, placebo 4.2% vs. dapagliflozin 3.7%; no PAD, placebo 0.4% vs. dapagliflozin 0.4%) (Pinteraction = 1.00). Infection rather than ischaemia was the main trigger for amputation, even in patients with PAD.

conclusionThe risk of worsening HF or cardiovascular death was higher in patients with PAD, as was the risk of amputation. The benefits of dapagliflozin were consistent in patients with and without PAD, and dapagliflozin did not increase the risk of amputation.

Indexed as

Diabetes Mellitus, Type 2Heart FailurePeripheral Arterial DiseaseSodium-Glucose Transporter 2 InhibitorsBenzhydryl CompoundsGlucosidesHumansStroke VolumeBenzhydryl CompoundsdapagliflozinGlucosidesSodium-Glucose Transporter 2 InhibitorsAmputationClinical trialHeart failure with preserved ejection fractionHeart failure with reduced ejection fractionPeripheral artery disease

Identifiers

PMID37220172
PMCPMC10290876
OpenAlexW4377861398

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.