Safety and Efficacy of Adding Dapagliflozin to Furosemide in Type 2 Diabetic Patients With Decompensated Heart Failure and Reduced Ejection Fraction

Ayman Ibrahim, Ramadan Ghaleb, Hossam Mansour, Amr Hanafy, Naggeh M Mahmoud, Mohamed Abdelfatah Elsharef, Mohamed Kamal Salama, Saud M Elsaughier, Lobna Abdel-Wahid, Mona Embarek Mohamed, Ahmed K Ibrahim, Ahmed Abdel-Galeel, Ayman Ibrahim, Ramadan Ghaleb, Hossam Mansour, Amr Hanafy, Naggeh M Mahmoud, Mohamed Abdelfatah Elsharef, Mohamed Kamal Salama, Saud M Elsaughier, Lobna Abdel-Wahid, Mona Embarek Mohamed, Ahmed K Ibrahim, Ahmed Abdel-Galeel

Abstract

Background: Heart failure is the most common cause of hospitalization in elderly patients. It is likely that many of the mechanisms that contribute to reductions in systolic and diastolic function, seen in diabetic patients, place them at an increased risk of heart failure. Diuretic therapy, especially loop diuretics, is the usual way of managing congestion, particularly in volume-overloaded patients. Little is known about the beneficial effect of dapagliflozin when added to loop diuretics in managing patients with decompensated heart failure. Aim: To assess the effect of the addition of dapagliflozin to furosemide in managing decompensated patient with heart failure and reduced left ventricular ejection fraction in terms of weight loss and dyspnea improvement. Patients and Methods: The study included 100 type 2 diabetic patients who were admitted with decompensated heart failure. The study population was randomly divided into two arms. Serum electrolytes and kidney functions were followed up during their hospital stay. Results: With dapagliflozin, there was a statistically significant difference between the two groups regarding the change in body weight and body mass index. The diuresis parameters including urine output, total fluid loss, and fluid balance also showed a statistically significant difference in favor of the use of dapagliflozin, with no significant change in serum potassium or kidney functions. There was significant improvement in patient-reported dyspnea scores with the use of dapagliflozin. Conclusions: Dapagliflozin may provide a new drug option in the treatment of heart failure especially among vulnerable group of diabetics. It had no remarkable effects on serum potassium level and kidney functions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04385589.

Keywords: dapagliflozin; diabetes mellitus; diuretic; furosemide; heart failure.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2020 Ibrahim, Ghaleb, Mansour, Hanafy, Mahmoud, Abdelfatah Elsharef, Kamal Salama, Elsaughier, Abdel-Wahid, Embarek Mohamed, Ibrahim and Abdel-Galeel.

Figures

Figure 1
Figure 1
Enrollment and follow up of the study population.
Figure 2
Figure 2
Mean percent change in the body weight on discharge.
Figure 3
Figure 3
Change in the dyspnea grades on admission vs on discharge.

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