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DELIVER was a large randomized trial of dapagliflozin in patients with heart failure and a mildly reduced or preserved ejection fraction. Dapagliflozin significantly reduced the composite of worsening heart failure or cardiovascular death compared with placebo, extending SGLT2 evidence across the heart-failure spectrum. The benefit was seen irrespective of diabetes status. For internists, the result is important because HFpEF is frequently managed alongside obesity, hypertension, diabetes and chronic kidney disease. Rather than waiting for a single disease-specific therapy, SGLT2 inhibition can now be considered as part of the broader treatment pathway in eligible patients. Monitoring volume status, renal function and tolerability remains necessary, but the key practical point is that glucose lowering is not the primary reason for use in heart failure. DELIVER also supports a phenotype-based approach in which comorbidities are treated together rather than in separate silos.
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DELIVER was a large randomized trial of dapagliflozin in patients with heart failure and a mildly reduced or preserved ejection fraction. Dapagliflozin significantly reduced the composite of worsening heart failure or cardiovascular death compared with placebo, extending SGLT2 evidence across the heart-failure spectrum. The benefit was seen irrespective of diabetes status. For internists, the result is important because HFpEF is frequently managed alongside obesity, hypertension, diabetes and chronic kidney disease. Rather than waiting for a single disease-specific therapy, SGLT2 inhibition can now be considered as part of the broader treatment pathway in eligible patients. Monitoring volume status, renal function and tolerability remains necessary, but the key practical point is that glucose lowering is not the primary reason for use in heart failure. DELIVER also supports a phenotype-based approach in which comorbidities are treated together rather than in separate silos.
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