Impact of Dapagliflozin on Anaemia in DAPA-HF

Sarfaroj Khan 


March 08, 2021


  • This post hoc analysis of DAPA-HF trial found that anaemia was common in patients with heart failure and reduced ejection fraction (HFrEF) and was associated with worse outcomes, especially if persistent.

  • Dapagliflozin corrected anaemia more often than placebo and improved outcomes, regardless of anaemia status at baseline.

Why this matters

  • Findings suggest that in many patients with HFrEF, anaemia is transient and reversible, but that when it persists, it is associated with poorer outcomes.

Study design

  • DAPA-HF was a phase 3, placebo-controlled trial involving 4744 patients with HFrEF and left ventricular ejection fraction of ≤40%.

  • This post hoc analysis evaluated the effect of dapagliflozin on correction of anaemia in patients with HFrEF.

  • The primary outcome was a composite of worsening heart failure (HF) (hospitalisation or urgent visit requiring intravenous therapy) or cardiovascular (CV) death.

  • Funding: AstraZeneca.

Key results

  • 4691 patients had a haematocrit available at baseline, of which 1032 (22.0%) were anaemic.

  • The rate of the primary outcome was higher in patients with anaemia vs those without (16.1 vs 12.9 per 100 person-years; adjusted HR, 1.06; 95% CI, 0.91-1.25; P=.45).

  • Anaemia was corrected in 62.2% of patients in the dapagliflozin group vs 41.1% of patients in the placebo group (OR, 2.37; 95% CI, 1.84-3.04; P<.001).

  • The beneficial effect of dapagliflozin vs placebo on the primary outcome was consistent in patients with anaemia vs those without (HR, 0.68; 95% CI, 0.52-0.88 vs HR, 0.76; 95% CI, 0.65-0.89; Pinteraction=.44).

  • Similar findings were observed for:

    • CV death (Pinteraction=.48);

    • HF hospitalisation (Pinteraction=.48);

    • all-cause mortality (Pinteraction=.67); and

    • total HF hospitalisations and CV death (Pinteraction=.30).

  • Patients with resolution of anaemia had better outcomes vs those in which anaemia persisted (rate of primary outcome: 19.7 vs 27.7 per 100 person-years).


  • Post hoc analysis.


Docherty KF, Curtain JP, Anand IS, Bengtsson O, Inzucchi SE, Køber L, Kosiborod MN, Langkilde AM, Martinez FA, Ponikowski P, Sabatine MS, Schou M, Sjöstrand M, Solomon SD, Jhund PS, McMurray JJV. Effect of dapagliflozin on anaemia in DAPA-HF. Eur J Heart Fail. 2021 Feb 22 [Epub ahead of print]. doi: 10.1002/ejhf.2132. PMID: 33615642.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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