2024
Effects of dapagliflozin in heart failure according to duration of type 2 diabetes: a patient-level meta-analysis of DAPA-HF and DELIVER
Butt J, De Boer R, Hernandez A, Inzucchi S, Kosiborod M, Koeber L, Lam C, Martinez F, Ponikowski P, Sabatine M, Shah S, Vaduganathan M, Jhund P, Solomon S, Mcmurray J. Effects of dapagliflozin in heart failure according to duration of type 2 diabetes: a patient-level meta-analysis of DAPA-HF and DELIVER. European Heart Journal 2024, 45: ehae666.1097. DOI: 10.1093/eurheartj/ehae666.1097.Peer-Reviewed Original ResearchEffects of dapagliflozinT2D durationHeart failureEjection fractionPrimary outcomeDAPA-HFCardiovascular deathNew York Heart Association functional classPro-B-type natriuretic peptide levelsN-terminal pro-B-type natriuretic peptide levelsComposite of worsening HFLeft ventricular ejection fractionPatient-level pooled analysisRisk of worsening HFAssociated with worse outcomesDuration of type 2 diabetesSafety of dapagliflozinPatient-level meta-analysisBenefits of dapagliflozinNatriuretic peptide levelsVentricular ejection fractionReduced ejection fractionHistory of T2DDuration of HFDuration of T2DIn‐hospital course of patients with heart failure with improved ejection fraction in the DELIVER trial
Pabon M, Vaduganathan M, Claggett B, Chatur S, Siqueira S, Marti‐Castellote P, de Boer R, Hernandez A, Inzucchi S, Kosiborod M, Lam C, Martinez F, Shah S, Desai A, Jhund P, McMurray J, Solomon S, Vardeny O. In‐hospital course of patients with heart failure with improved ejection fraction in the DELIVER trial. European Journal Of Heart Failure 2024 PMID: 39300780, DOI: 10.1002/ejhf.3410.Peer-Reviewed Original ResearchLeft ventricular ejection fractionCourse of patientsIn-hospital courseHF hospitalizationHeart failureIn-hospital mortalityEjection fractionClinical courseLeft ventricular ejection fraction changesLeft ventricular ejection fraction measurementsClinical course of patientsIn-hospital clinical courseRisk of clinical eventsMechanical fluid removalStandard diuretic therapyMedian follow-upVentricular ejection fractionNon-invasive ventilationIntensive care unitClinical Endpoint CommitteeTime of enrollmentMechanical circulatory supportLength of stayDiuretic therapyHFimpEFEffects of dapagliflozin according to QRS duration across the spectrum of left ventricular ejection fraction: An analysis of DAPA‐HF and DELIVER
Abdin A, Kondo T, Böhm M, Jhund P, Claggett B, Vaduganathan M, Hernandez A, Lam C, Inzucchi S, Martinez F, de Boer R, Desai A, Køber L, Sabatine M, Petersson M, Bachus E, Solomon S, McMurray J, Committees and Investigators O. Effects of dapagliflozin according to QRS duration across the spectrum of left ventricular ejection fraction: An analysis of DAPA‐HF and DELIVER. European Journal Of Heart Failure 2024, 26: 1952-1963. PMID: 39016033, DOI: 10.1002/ejhf.3350.Peer-Reviewed Original ResearchLeft ventricular ejection fractionSpectrum of left ventricular ejection fractionEffects of dapagliflozinProlongation of QRS durationVentricular ejection fractionQRS durationEjection fractionDAPA-HFHeart failurePrimary outcomeHF phenotypesPrimary composite outcome of cardiovascular deathMedian follow-up timeComposite outcome of cardiovascular deathOutcome of cardiovascular deathAssociated with worse outcomesReduced ejection fractionCardiac resynchronization therapyFollow-up timePrimary composite outcomeFavorable ventricular remodelingWorsening HFResynchronization therapyPharmacological therapyVentricular remodelingEffect of dapagliflozin in patients with diabetes and heart failure with mildly reduced or preserved ejection fraction according to background glucose‐lowering therapy: A pre‐specified analysis of the DELIVER trial
Lassen M, Ostrominski J, Inzucchi S, Claggett B, Kulac I, Jhund P, de Boer R, Hernandez A, Kosiborod M, Lam C, Martinez F, Shah S, Desai A, Petersson M, Langkilde A, Docherty K, McMurray J, Solomon S, Vaduganathan M. Effect of dapagliflozin in patients with diabetes and heart failure with mildly reduced or preserved ejection fraction according to background glucose‐lowering therapy: A pre‐specified analysis of the DELIVER trial. European Journal Of Heart Failure 2024, 26: 1539-1548. PMID: 38745498, DOI: 10.1002/ejhf.3269.Peer-Reviewed Original ResearchConceptsBackground glucose-lowering therapyLeft ventricular ejection fractionGlucose-lowering therapySodium-glucose cotransporter 2 inhibitorsHeart failureClinical outcomesComposite of worsening HFPrimary outcomeInsulin useBenefits of dapagliflozinVentricular ejection fractionEffects of dapagliflozinType 2 diabetesEjection fractionRandomized patientsMetformin useConcomitant metforminCardiovascular deathFollow-upContemporary guidelinesDapagliflozinTreatment effectsDELIVER trialTreatment benefitT2DDapagliflozin and quality of life measured using the EuroQol 5‐dimension questionnaire in patients with heart failure with reduced and mildly reduced/preserved ejection fraction
Yang M, Kondo T, Talebi A, Jhund P, Docherty K, Claggett B, Vaduganathan M, Bachus E, Hernandez A, Lam C, Inzucchi S, Martinez F, de Boer R, Kosiborod M, Desai A, Køber L, Ponikowski P, Sabatine M, Solomon S, McMurray J. Dapagliflozin and quality of life measured using the EuroQol 5‐dimension questionnaire in patients with heart failure with reduced and mildly reduced/preserved ejection fraction. European Journal Of Heart Failure 2024, 26: 1524-1538. PMID: 38700986, DOI: 10.1002/ejhf.3263.Peer-Reviewed Original ResearchConceptsVisual analogue scaleEjection fractionEQ-5D-5L visual analogue scaleHealth-related quality of lifeIndex scorePatient-level pooled analysisComposite of cardiovascular deathQuality of lifeSafety of dapagliflozinEffects of dapagliflozinReduced ejection fractionAssociated with better outcomesPrevalence of comorbiditiesEuroQol 5-dimension questionnaireMeasures of health-related quality of lifePatient self-reportDAPA-HFWorsening HFVAS scoreClinical characteristicsAtrial fibrillationComposite outcomeHeart failurePooled analysisAnalogue scaleDapagliflozin and Days of Full Health Lost in the DAPA-HF Trial
Kondo T, Mogensen U, Talebi A, Gasparyan S, Campbell R, Docherty K, de Boer R, Inzucchi S, Køber L, Kosiborod M, Martinez F, Sabatine M, Bengtsson O, Sjöstrand M, Vaduganathan M, Solomon S, Jhund P, McMurray J. Dapagliflozin and Days of Full Health Lost in the DAPA-HF Trial. Journal Of The American College Of Cardiology 2024, 83: 1973-1986. PMID: 38537918, DOI: 10.1016/j.jacc.2024.03.385.Peer-Reviewed Original ResearchConceptsDAPA-HFLeft ventricular ejection fractionNYHA functional class IIEfficacy of dapagliflozinFunctional class IIIV heart failureVentricular ejection fractionEffects of dapagliflozinHeart failure hospitalizationDAPA-HF trialWell-beingFollow-up daysBetween-treatment differencesDapagliflozin groupPlacebo groupTime-to-first-event analysisEjection fractionFailure hospitalizationPatient well-beingHeart failureCardiovascular deathDapagliflozinRecurrent hospitalizationsClass IIPlaceboDapagliflozin in patients with heart failure and previous myocardial infarction: A participant‐level pooled analysis of DAPA‐HF and DELIVER
Peikert A, Vaduganathan M, Claggett B, Kulac I, Foà A, Desai A, Jhund P, Carberry J, Lam C, Kosiborod M, Inzucchi S, Martinez F, de Boer R, Hernandez A, Shah S, Køber L, Ponikowski P, Sabatine M, Petersson M, Langkilde A, McMurray J, Solomon S. Dapagliflozin in patients with heart failure and previous myocardial infarction: A participant‐level pooled analysis of DAPA‐HF and DELIVER. European Journal Of Heart Failure 2024, 26: 912-924. PMID: 38487939, DOI: 10.1002/ejhf.3184.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionHeart failureHistory of MIMyocardial infarctionPrimary outcomeDAPA-HFWorsening HFSpectrum of left ventricular ejection fractionLeft ventricular ejection fraction spectrumCardiovascular deathSodium-glucose cotransporter 2 inhibitorsRisk of disease progressionComposite of cardiovascular deathRisk of adverse cardiovascular outcomesIncreased risk of adverse cardiovascular outcomesRisk of cardiovascular deathVentricular ejection fractionHistory of myocardial infarctionSerious adverse eventsAdverse cardiovascular outcomesSymptomatic HFEjection fractionAdverse eventsCovariate-adjusted modelsPooled analysisDapagliflozin and Mode of Death in Heart Failure With Improved Ejection Fraction
Vardeny O, Desai A, Jhund P, Fang J, Claggett B, de Boer R, Hernandez A, Inzucchi S, Kosiborod M, Lam C, Martinez F, Shah S, Mc Causland F, Petrie M, Vaduganathan M, McMurray J, Solomon S. Dapagliflozin and Mode of Death in Heart Failure With Improved Ejection Fraction. JAMA Cardiology 2024, 9: 283-289. PMID: 38265835, PMCID: PMC10809142, DOI: 10.1001/jamacardio.2023.5318.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionMode of deathEjection fractionCause-specific deathHeart failureCardiovascular deathNew York Heart Association class IIGuideline-directed medical therapyStudy case report formsSudden deathVentricular ejection fractionRate of sudden deathAssociated with lower ratesCox regression modelsImproved ejection fractionRandomized clinical trialsReduce cardiovascular mortalityCase report formsEnd-point committeeClinical end point committeePost hoc analysisDapagliflozin EvaluationIV symptomsHFimpEFMedical therapyDecline in Estimated Glomerular Filtration Rate After Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction
Mc Causland F, Claggett B, Vaduganathan M, Desai A, Jhund P, Vardeny O, Fang J, de Boer R, Docherty K, Hernandez A, Inzucchi S, Kosiborod M, Lam C, Martinez F, Saraiva J, McGrath M, Shah S, Verma S, Langkilde A, Petersson M, McMurray J, Solomon S. Decline in Estimated Glomerular Filtration Rate After Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction. JAMA Cardiology 2024, 9: 144-152. PMID: 37952176, PMCID: PMC10641768, DOI: 10.1001/jamacardio.2023.4664.Peer-Reviewed Original ResearchSodium-glucose cotransporter 2 inhibitorsEGFR declineGlomerular filtration rateEjection fractionHeart failurePrespecified analysisFiltration rateMonths 1Estimated glomerular filtration rateDapagliflozin-treated patientsKidney composite outcomePrimary cardiovascular outcomeHeart Failure TrialChronic kidney diseaseCotransporter 2 inhibitorsInternational multicenter studyLives of patientsBaseline eGFRKidney eventsKidney outcomesCardiovascular outcomesComposite outcomePrognostic factorsFailure TrialMulticenter studyCardiac And Kidney Benefits Of Dapagliflozin Are Associated With ApoM Levels In Patients With Heart Failure With Reduced Ejection Fraction
Chang J, Javaheri A, Sauer A, Windsor S, Fu Z, Jones P, Margulies K, Lanfear D, Nassif M, Husain M, Inzucchi S, McGuire D, Pitt B, Scirica B, Kosiborod M. Cardiac And Kidney Benefits Of Dapagliflozin Are Associated With ApoM Levels In Patients With Heart Failure With Reduced Ejection Fraction. Journal Of Cardiac Failure 2024, 30: 236. DOI: 10.1016/j.cardfail.2023.10.284.Peer-Reviewed Original ResearchSodium-glucose cotransporter 2 inhibitorsUrine albumin-creatinine ratioLog-transformed NT-proBNPLog-transformed NT-proBNP levelsDapagliflozin-treated patientsNT-proBNP levelsReduced ejection fractionNT-proBNPHeart failureApoM levelsEjection fractionType 2 diabetes mellitusPlacebo-treated patientsAlbumin-creatinine ratioCotransporter 2 inhibitorsEffect of dapagliflozinMultivariable linear regressionSphingosine-1-PhosphateKidney benefitsSGLT2i dapagliflozinDapagliflozin groupHF trialsPlacebo groupDapagliflozin treatmentOverall cohort
2023
Heart Failure, Investigator-Reported Sleep Apnea and Dapagliflozin: A Patient-Level Pooled Meta-Analysis of DAPA-HF and DELIVER
Butt J, Jering K, DE Boer R, Claggett B, Desai A, Hernandez A, Inzucchi S, Jhund P, Køber L, Kosiborod M, Lam C, Martinez F, Ponikowski P, Sabatine M, Shah S, Vaduganathan M, Langkilde A, Bengtsson O, Petersson M, Sjöstrand M, Wilderäng U, Solomon S, McMurray J. Heart Failure, Investigator-Reported Sleep Apnea and Dapagliflozin: A Patient-Level Pooled Meta-Analysis of DAPA-HF and DELIVER. Journal Of Cardiac Failure 2023, 30: 436-448. PMID: 38104937, DOI: 10.1016/j.cardfail.2023.08.027.Peer-Reviewed Original ResearchConceptsHistory of sleep apneaPrevalence of sleep apneaEffects of dapagliflozinSleep apneaWorsening HF eventsDAPA-HFAssociated with higher ratesHeart failureClinical outcomesEjection fractionPooled analysisComposite of worsening HFEffects of HF therapiesPrimary outcomeHF eventsDELIVER trialBenefits of dapagliflozinDAPA-HF trialAssociated with outcomePrimary endpointHF therapyHigher ratesHF phenotypesApneaTreatment optionsEffects of Dapagliflozin in Patients in Asia A Post Hoc Subgroup Analysis From the DELIVER Trial
Wang X, Lam C, Vaduganathan M, Kondo T, Yang M, Han Y, Pham V, Chiang C, Kitakaze M, Miao Z, Jhund P, Desai A, Inzucchi S, de Boer R, Martinez F, Kosiborod M, Hernandez A, Claggett B, Langkilde A, McMurray J, Solomon S. Effects of Dapagliflozin in Patients in Asia A Post Hoc Subgroup Analysis From the DELIVER Trial. JACC Asia 2023, 4: 108-118. PMID: 38371292, PMCID: PMC10866733, DOI: 10.1016/j.jacasi.2023.10.005.Peer-Reviewed Original ResearchEffects of dapagliflozinHeart failureDELIVER trialClinical characteristicsRisk of primary composite outcomesRate of drug discontinuationLeft ventricular ejection fractionRisk of all-cause mortalityRisk of CV deathEfficacy of dapagliflozinWorsening HF eventsVentricular ejection fractionHistory of myocardial infarctionSerious adverse eventsPrimary composite outcomeAll-cause mortalityClinically relevant characteristicsDrug discontinuationEjection fractionAdverse eventsCV deathTreatment armsComposite outcomeSubgroup analysisPrimary outcomeEffect of dapagliflozin on outpatient worsening heart failure in patients with mildly reduced or preserved ejection fraction: the DELIVER trial
Chatur S, Vaduganathan M, Claggett B, Desai A, Docherty K, Jhund P, De Boer R, Hernandez A, Inzucchi S, Kosiborod M, Lam C, Martinez F, Shah S, Mcmurray J, Solomon S. Effect of dapagliflozin on outpatient worsening heart failure in patients with mildly reduced or preserved ejection fraction: the DELIVER trial. European Heart Journal 2023, 44: ehad655.751. DOI: 10.1093/eurheartj/ehad655.751.Peer-Reviewed Original ResearchUrgent HF visitsHeart failureHF eventsHF hospitalizationHF visitsEjection fractionFirst presentationSubsequent mortalityComposite endpointSubsequent deathEffect of dapagliflozinTreatment effectsBackground HospitalizationCV causesCV deathDose uptitrationPrimary endpointPrognostic importanceClinical trialsFirst manifestationLandmark analysisAmbulatory careHospitalizationClinical relevancePatientsEffects of dapagliflozin in heart failure with preserved ejection fraction and chronic obstructive pulmonary disease: an analysis of the DELIVER trial
Butt J, Lu H, Kondo T, Bachus E, De Boer R, Hernandez A, Inzucchi S, Jhund P, Kosiborod M, Lam C, Martinez F, Shah S, Vaduganathan M, Solomon S, Mcmurray J. Effects of dapagliflozin in heart failure with preserved ejection fraction and chronic obstructive pulmonary disease: an analysis of the DELIVER trial. European Heart Journal 2023, 44: ehad655.949. DOI: 10.1093/eurheartj/ehad655.949.Peer-Reviewed Original ResearchChronic obstructive pulmonary diseaseHeart failureCOPD statusEjection fractionN-terminal pro-B-type natriuretic peptide levelsHistory of COPDNew York Heart Association functional class IIPro-B-type natriuretic peptide levelsBaseline chronic obstructive pulmonary diseaseIntroduction Chronic obstructive pulmonary diseaseLower systolic blood pressureWorse NYHA functional classEfficacy of dapagliflozinHigher NT-proBNPPrior HF hospitalizationFunctional class IINatriuretic peptide levelsNYHA functional classEffect of dapagliflozinObstructive pulmonary diseaseSystolic blood pressureVentricular ejection fractionStructural heart diseaseHF hospitalizationCardiovascular deathEfficacy of dapagliflozin according to geographic regions in patients with heart failure: a patient-level pooled analysis of DAPA-HF and DELIVER
Kondo T, Vaduganathan V, Hernandez A, Lam C, Inzucchi S, Martinez F, De Boer R, Kosiborod M, Desai A, Kober L, Ponikowski P, Sabatine M, Shah S, Solomon S, Mcmurray J. Efficacy of dapagliflozin according to geographic regions in patients with heart failure: a patient-level pooled analysis of DAPA-HF and DELIVER. European Heart Journal 2023, 44: ehad655.979. DOI: 10.1093/eurheartj/ehad655.979.Peer-Reviewed Original ResearchLeft ventricular ejection fractionSafety of dapagliflozinHeart failureDAPA-HFPrimary outcomeEjection fractionMean baseline LVEFBaseline left ventricular ejection fractionPatient-level pooled analysisBackground clinical characteristicsBenefit of dapagliflozinEfficacy of dapagliflozinElevated natriuretic peptidesNatriuretic peptide levelsEffect of dapagliflozinMineralocorticoid receptor antagonistsVentricular ejection fractionCardiovascular deathClinical characteristicsDiscontinuation ratesStandard careHazard ratioPatient characteristicsNatriuretic peptidePooled analysisEfficacy of Dapagliflozin According to Heart Rate: A Patient-Level Pooled Analysis of DAPA-HF and DELIVER
Kondo T, Butt J, Curtain J, Jhund P, Docherty K, Claggett B, Vaduganathan M, Bachus E, Hernandez A, Lam C, Inzucchi S, Martinez F, de Boer R, Kosiborod M, Desai A, Køber L, Ponikowski P, Sabatine M, Solomon S, McMurray J. Efficacy of Dapagliflozin According to Heart Rate: A Patient-Level Pooled Analysis of DAPA-HF and DELIVER. Circulation Heart Failure 2023, 16: e010898. PMID: 37886880, DOI: 10.1161/circheartfailure.123.010898.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionReduced ejection fractionVentricular ejection fractionPatient-level pooled analysisBenefit of dapagliflozinEjection fractionHeart failureAtrial fibrillationBaseline heart rateSinus rhythmHeart ratePrimary outcomeDAPA-HFCardiovascular deathPooled analysisHR rangeEfficacy of dapagliflozinEffect of dapagliflozinHeart failure phenotypeHigher heart rateCardiovascular eventsHazard ratioHigh riskFailure phenotypePatientsDapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial
Ostrominski J, Vaduganathan M, Selvaraj S, Claggett B, Miao Z, Desai A, Jhund P, Kosiborod M, Lam C, Inzucchi S, Martinez F, de Boer R, Hernandez A, Shah S, Petersson M, Langkilde A, McMurray J, Solomon S. Dapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial. Circulation 2023, 148: 1945-1957. PMID: 37830208, DOI: 10.1161/circulationaha.123.065254.Peer-Reviewed Original ResearchConceptsApparent treatment-resistant hypertensionBaseline blood pressureTreatment-resistant hypertensionVentricular ejection fractionEjection fractionNonresistant hypertensionPrimary outcomeHeart failureBP categoriesHigher left ventricular ejection fractionSystolic baseline blood pressureLeft ventricular ejection fractionRelative treatment benefitSerious adverse eventsKey secondary outcomesRisk of hypotensionWorse kidney functionHigh-risk populationProportion of participantsBaseline BP categoriesGreater absolute reductionCardiometabolic comorbiditiesHypertension groupVascular eventsAdverse eventsImpact of COVID‐19 in patients with heart failure with mildly reduced or preserved ejection fraction enrolled in the DELIVER trial
Bhatt A, Kosiborod M, Claggett B, Miao Z, Vaduganathan M, Lam C, Hernandez A, Martinez F, Inzucchi S, Shah S, de Boer R, Jhund P, Desai A, Fang J, Han Y, Comin‐Colet J, Drożdż J, Vardeny O, Merkely B, Lindholm D, Peterson M, Langkilde A, McMurray J, Solomon S. Impact of COVID‐19 in patients with heart failure with mildly reduced or preserved ejection fraction enrolled in the DELIVER trial. European Journal Of Heart Failure 2023, 25: 2177-2188. PMID: 37771274, DOI: 10.1002/ejhf.3043.Peer-Reviewed Original ResearchCOVID-19 diagnosisRisk of deathHeart failureEjection fractionPandemic onsetTrial participantsCOVID-19Death rateMajor hypoglycaemic eventsChronic heart failureTime of diagnosisCOVID-19 survivorsDiabetic ketoacidosisHypoglycaemic eventsClinical outcomesHF eventsCOVID-19 casesTreatment benefitClinical riskCardiovascular trialsDeath/DapagliflozinEvent ratesPatientsDiagnosisContemporary Use and Implications of Beta-Blockers in Patients With HFmrEF or HFpEF The DELIVER Trial
Peikert A, Bart B, Vaduganathan M, Claggett B, Kulac I, Kosiborod M, Desai A, Jhund P, Lam C, Inzucchi S, Martinez F, de Boer R, Hernandez A, Shah S, Petersson M, Langkilde A, McMurray J, Solomon S, Vardeny O. Contemporary Use and Implications of Beta-Blockers in Patients With HFmrEF or HFpEF The DELIVER Trial. JACC Heart Failure 2023, 12: 631-644. PMID: 37767674, DOI: 10.1016/j.jchf.2023.09.007.Peer-Reviewed Original ResearchBeta-blocker useLeft ventricular ejection fractionHeart failureEjection fractionPrimary outcomeCardiovascular deathAmerican Heart Association/American CollegeSymptomatic heart failureKey secondary endpointVentricular ejection fractionLatest European SocietyCovariate-adjusted modelsSecondary endpointsPrespecified analysisAdverse eventsAmerica guidelinesComorbidity managementChronotropic responseClinical outcomesClinical eventsSafety outcomesAmerican CollegeHigh riskHFpEFLower riskHeart failure, chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction: Insights from DELIVER
Butt J, Lu H, Kondo T, Bachus E, de Boer R, Inzucchi S, Jhund P, Kosiborod M, Lam C, Martinez F, Vaduganathan M, Solomon S, McMurray J. Heart failure, chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction: Insights from DELIVER. European Journal Of Heart Failure 2023, 25: 2078-2090. PMID: 37634087, DOI: 10.1002/ejhf.3000.Peer-Reviewed Original ResearchConceptsChronic obstructive pulmonary diseaseModerate chronic obstructive pulmonary diseaseCOPD statusSafety of dapagliflozinObstructive pulmonary diseaseHeart failurePulmonary diseasePrimary outcomeEjection fractionWorse outcomesKansas City Cardiomyopathy Questionnaire scoreBenefit of dapagliflozinPre-specified analysisSevere pulmonary diseaseCardiovascular deathCause hospitalizationPrimary endpointTreatment discontinuationAdverse eventsClinical eventsQuestionnaire scoresPlaceboDapagliflozinPatientsKnown history