Alexander Peikert

🧵 The DAPA ACT HF-TIMI 68 trial 💡starting #dapagliflozin (10 mg/d) during #HeartFailure hospitalization reduces early CV death or worsening HF vs placebo. 💁‍♂️2,401 pts, double-blind, 210 centers. 🎯Results: Primary composite outcome (CV death/worsening HF at 2 months): •Dapagliflozin: 10.9% •Placebo: 12.7% •HR: 0.86 (95% CI 0.68–1.08, p=0.20).
Not statistically significant. 📉 🔑Key numbers: •71% had LVEF ≤40%. •45% newly diagnosed. •Strong outpatient guideline-directed RX at discharge (88% beta-blockers, 76% RAASi, 54% MRA). •Median follow-up: 60 days. 👨‍⚕️ 🎯Secondary outcomes: •CV death: 2.5% dapagliflozin vs 3.1% placebo (HR 0.78) •All-cause death: 3.0% vs 4.5% (HR 0.66, 95% CI 0.43-1.00). •Data suggest potential mortality benefit, but requires caution. 5/ Safety: •Higher rates of symptomatic hypotension (3.6%) & worsening renal function (5.9%) in dapagliflozin arm. •Low rates of hypoglycemia, no DKA. 🧮Meta-analysis (3 studies, n=3,527): •In-hospital #SGLT2i ⬇️ risk of early CV death or worsening HF by 29% (HR 0.71), all-cause death by 43% (HR 0.57). 🏡Conclusions: •Starting dapagliflozin in-hospital didn’t significantly lower primary composite events in 2 months. •Meta-analysis supports early #SGLT2i for reduced CV events/all-cause death in acute #HF. •Initiation appears safe with considerations #ESC2025