Dapagliflozin After Transcatheter Aortic Valve Implantation According to Frailty in DapaTAVI Trial

Background Frailty is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and portends worse outcomes. Whether the benefit of posttranscatheter aortic valve implantation dapagliflozin differs by frailty is uncertain. Methods In this post hoc analysis, we investigated the efficacy of dapagliflozin according to frailty status in the DapaTAVI (Dapagliflozin in Patients Undergoing Transcatheter Aortic Valve Implantation) trial. Frailty was assessed through the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (robust=0, prefrail=1–2, frail=3–5). The primary outcome was the composite of all‐cause death or worsening heart failure at 1 year. Results Among 1222 patients with baseline frailty assessment, 47.2% were frail, 40.3% prefrail, and 12.4% robust. Over 12 months, 215 patients (17.6%) experienced the primary end point. Patients who were prefrail and frail had higher risk than robust patients (adjusted hazard ratios [HRs], 1.88 [95% CI, 1.05–3.38] and 2.29 [1.29–4.07], respectively; P =0.004). Dapagliflozin was associated with a lower risk of the primary end point in patients who were frail (HR, 0.53 [95% CI, 0.36–0.77]) but not in those who were prefrail (HR, 1.01 [95% CI, 0.66–1.55]) or robust patients (HR, 1.26 [95% CI, 0.42–3.75]); P for interaction=0.021. There was no evidence that frailty modified the safety profile of dapagliflozin. Conclusions Frailty was common and independently associated with worse outcomes after transcatheter aortic valve implantation. Dapagliflozin appeared to confer greater relative benefit in patients with frailty.

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Journal
Journal of the American Heart Association
Published
2026-10-16
DOI
https://doi.org/10.1161/jaha.126.051379
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Dapagliflozin After Transcatheter Aortic Valve Implantation According to Frailty in DapaTAVI Trial

Soledad Ojeda, Rafael Romaguera, Miriam Sandín Rollán, Juan Gabriel Cordoba-Soriano et al.
Journal of the American Heart Association
Cardiac Valve Diseases and Treatments
article

Dapagliflozin After Transcatheter Aortic Valve Implantation According to Frailty in DapaTAVI Trial

Soledad Ojeda, Rafael Romaguera, Miriam Sandín Rollán, Juan Gabriel Cordoba-Soriano, Victòria Vilalta, Jorge Sanz‐Sánchez, Ricardo Palma-Carbajal, Albert Ariza‐Solé, Rafael González Manzanares, Borja Ibáñez, Nieves Gonzalo, Livia Luciana Gheorghe, Pedro Luis Cepas Guillén, Eduard Fernández‐Nofrerías, Sergio Raposeiras‐Roubín, Ignacio Jesus Amat-Santos, Xavier Rosselló, Diego López‐Otero, Xoán Sanmartín, Germán Calle, Rafael Cobas Paz, Rocío González-Ferreiro, Sandra Santos‐Martínez, Valentı́n Fuster, Luis Nombela-Franco y, Sergio García‐Blas, Gabriela Tirado‐Conte, Gabriela Veiga Fernández, Pablo Avanzas y, José Luis Díez Gil, Antonio Jesús Muñoz García, Roberto Martín Reyes, Javier Martín Moreiras, Erika Muñoz García, Inmaculada González Bermúdez, Ignacio Gallo, Juan A. Franco-Peláez, José Ramón Gonzalez Juanatey, Carlos Baladrón Zorita, Xacobe Flores Ríos, Alejandro Gutierrez Barri
article en

Abstract

Background Frailty is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and portends worse outcomes. Whether the benefit of posttranscatheter aortic valve implantation dapagliflozin differs by frailty is uncertain. Methods In this post hoc analysis, we investigated the efficacy of dapagliflozin according to frailty status in the DapaTAVI (Dapagliflozin in Patients Undergoing Transcatheter Aortic Valve Implantation) trial. Frailty was assessed through the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (robust=0, prefrail=1–2, frail=3–5). The primary outcome was the composite of all‐cause death or worsening heart failure at 1 year. Results Among 1222 patients with baseline frailty assessment, 47.2% were frail, 40.3% prefrail, and 12.4% robust. Over 12 months, 215 patients (17.6%) experienced the primary end point. Patients who were prefrail and frail had higher risk than robust patients (adjusted hazard ratios [HRs], 1.88 [95% CI, 1.05–3.38] and 2.29 [1.29–4.07], respectively; P =0.004). Dapagliflozin was associated with a lower risk of the primary end point in patients who were frail (HR, 0.53 [95% CI, 0.36–0.77]) but not in those who were prefrail (HR, 1.01 [95% CI, 0.66–1.55]) or robust patients (HR, 1.26 [95% CI, 0.42–3.75]); P for interaction=0.021. There was no evidence that frailty modified the safety profile of dapagliflozin. Conclusions Frailty was common and independently associated with worse outcomes after transcatheter aortic valve implantation. Dapagliflozin appeared to confer greater relative benefit in patients with frailty.

Journal of the American Heart Association
Universidade de Santiago de Compostela (ES), Bellvitge University Hospital (ES), University Hospital Complex Of Vigo (ES), Spanish National Centre for Cardiovascular Research (ES), Hospital Clínico San Carlos (ES), Hospital Universitari i Politècnic La Fe (ES), Hospital La Luz (ES), Instituto Maimónides de Investigación Biomédica de Córdoba (ES), Hospital Clínico Universitario de Valencia (ES), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Complejo Hospitalario Universitario de Santiago (ES), Marqués de Valdecilla University Hospital (ES), Instituto de Investigación Marqués de Valdecilla (ES), Hospital Quirónsalud Barcelona (ES), Centro de Investigación Biomédica en Red (ES), Hospital Universitario Reina Sofía (ES), Vall d'Hebron Hospital Universitari (ES), Hospital Universitario Fundación Jiménez Díaz (ES), Hospital Universitario Central de Asturias (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Hospital Universitario Puerta del Mar (ES), Hospital General Universitario de Albacete (ES), Universidad San Carlos (PY), Hospital Universitari Germans Trias i Pujol (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Clínico Universitario de Valladolid (ES), INCLIVA Health Research Institute (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Hospital Montecelo (ES), Universitat de les Illes Balears (ES), University of Córdoba (ES), Icahn School of Medicine at Mount Sinai (US)
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Cardiac Valve Diseases and Treatments
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