Abstract

Background: The use of sodium-glucose cotransporter-2 inhibitor (SGLT2i)dapagliflozin 10 mg in the clinical routine care of patients (pts) with heart failure (HF)with reduced ejection fraction (HFrEF) across various geographies is less known. Purpose: This study described the baseline (BL) characteristics and treatment usein HFrEF pts initiating dapagliflozin in real-life settings in 9 countries from Central Eastern Europe and Baltic Area (CEE-BA), as part of the real-world evidence program EVOLUTION-HF. Methods: EVOLUTION-HF CEE-BA was a longitudinal cohort study. Investigators from 102 sites collected study data from medical files of adults pts with HFrEF newly initiated on dapagliflozin in accordance with the local label, with no previousSGLT2i use or type 1 diabetes. All pts provided written informed consent. Pts were followed-up at 6 and 12 months (mo) since dapagliflozin start (BL) or until study discontinuation. Descriptive statistics were used. At the time of study conduct,SGLT2i were not reimbursed for HF in several participating countries. Results: 1131 eligible pts were included, 836 (74%) males, mean (SD) age at dapagliflozin start 66.8 (11.4) years, and 62.7 (12.1) years at HF diagnosis. At BL, New York Heart Association II/III/IV was reported in 52%/44%/3% of pts (unknown for 1%), ischemic HF in 585 (52%) pts, and non-ischemic HF in 460 (41%)(unknown for 8%). In the last year before dapagliflozin start 753 (67%) pts had no HF-hospitalization. Other BL characteristics are shown in Table 1. At BL,989 (87%) pts received renin-angiotensin system inhibitors (RASi), 1044 (92%)beta-blockers (BB), 815 (72%) mineralocorticoid receptor agonists (MRA), 677 (60%) RASi+BB+MRA, 858 (76%) diuretics, 600 (53%) anticoagulants and 499 (44%)antiplatelets. Overall, 330 (29%) pts received antidiabetic treatments. Dapagliflozin use over 1 year: number of dapagliflozin discontinuations per 100 patient years was 8.4 (95% confidence interval 6.7-10). Overall, 94 dapagliflozin discontinuation events were reported: 55 between BL and 6-mo follow-up (FU), 39 between 6- and12-month FU. At 6-mo FU 666 (59%) pts continued to receive guideline-directed medical therapy (GDMT) consisting of RASi+BB+MRA+dapagliflozin and 627 (59%)pts at 12-mo, respectively. Conclusions: In this CEE-BA cohort, the proportion of pts continuing to receive GDMT remained stable over 1 year, with a high dapagliflozin drug persistence. These findings show that HF treatment with SGLT2i as pillar of the GDMT strategy is beneficial over time.