DELIVER: what the trial showed
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. Results are summarized from the cited trial report and any companion publications listed below.
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 | Placebo | Effect |
|---|---|---|
| 16.4% (512 of 3,131) | 19.5% (610 of 3,132) | 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
Written for healthcare professionals as an orientation to the primary publication, not as a substitute for reading it. For literature search, education, and professional evidence review only. Not for diagnosis, treatment selection, triage, monitoring, prognosis, or patient-specific clinical decision-making.