# DELIVER: what the trial showed

Canonical page: https://cliniatlas.com/trials/deliver/

In 6,263 patients with heart failure and an ejection fraction above 40%, dapagliflozin 10 mg daily reduced worsening heart failure or cardiovascular death from 19.5% to 16.4% over a median of 2.3 years, extending the SGLT2 inhibitor benefit to HFmrEF and HFpEF.

**Main cited publication:** Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. New England Journal of Medicine (2022). PMID 36027570. https://pubmed.ncbi.nlm.nih.gov/36027570/

## At a glance

- Design: Randomised, double-blind, placebo-controlled, event-driven
- Population: 6,263 adults with heart failure and a left ventricular ejection fraction of more than 40%, on usual therapy, with or without diabetes
- Intervention: Dapagliflozin 10 mg once daily
- Comparator: Placebo
- Follow-up: Median 2.3 years
- Registration: NCT03619213
- Funding: AstraZeneca

## Primary outcome

Composite of worsening heart failure (unplanned hospitalisation or urgent visit) or cardiovascular death.

- Dapagliflozin 10 mg once daily: 16.4% (512 of 3,131)
- Placebo: 19.5% (610 of 3,132)
- Effect: Hazard ratio 0.82 (95% CI 0.73 to 0.92), P<0.001

## Key findings

- Worsening heart failure occurred in 11.8% versus 14.5% (HR 0.79, 95% CI 0.69 to 0.91).
- Cardiovascular death was 7.4% versus 8.3% (HR 0.88, 95% CI 0.74 to 1.05), not statistically significant on its own.
- Results were similar in patients with an ejection fraction of 60% or more and below 60%, and in patients with or without diabetes.
- Total events and symptom burden were lower with dapagliflozin.

## Harms and safety

- The incidence of adverse events was similar in the two groups.

## Limitations

- The benefit is driven by fewer heart failure events rather than by a clear mortality reduction.
- As with all placebo-controlled HFpEF trials, the population is defined by ejection fraction and natriuretic peptides, so patients with heart failure symptoms but low peptides are under-represented.
- Industry funded.

## Where it sits in guidelines

The 2023 focused update of the ESC heart failure guideline recommends an SGLT2 inhibitor (dapagliflozin or empagliflozin) in HFmrEF and HFpEF with a class I recommendation, based on DELIVER and EMPEROR-Preserved.

## CliniAtlas answers that use this trial

- https://cliniatlas.com/evidence/sglt2-inhibitors-heart-failure-preserved-ejection-fraction-hfpef/

Ask about this trial against live sources (free, no sign-in): https://cliniatlas.com/?q=What%20did%20the%20DELIVER%20trial%20show%20and%20how%20should%20it%20be%20interpreted%3F

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