DAPA-HF Response Predictor: Explanation and Clinical Context
The DAPA‑HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial demonstrated that dapagliflozin significantly reduced the risk of cardiovascular death or worsening heart failure in patients with heart failure and reduced ejection fraction (HFrEF). In subsequent analyses, investigators explored baseline variables to identify which patients derive greater relative or absolute benefit. For example, higher baseline risk (e.g., elevated natriuretic peptides, renal dysfunction) was associated with higher absolute benefit, though relative benefit remained broadly consistent across risk‐groups. This calculator aims to provide a predicted probability of greater benefit from dapagliflozin in HFrEF populations by integrating key baseline variables (age, sex, NYHA class, LVEF, renal function, biomarkers, diabetes). Users should interpret results as probabilistic, not deterministic: this is a tool to support risk/benefit discussion rather than sole decision-making.
How to interpret: A higher predicted probability suggests a greater likelihood of deriving substantial benefit from dapagliflozin in HFrEF with reduced LVEF. However, all eligible patients per guideline should be considered for SGLT2 inhibitor therapy regardless of score.
Limitations: The model is illustrative only, derived from simplified coefficients rather than a validated prognostic algorithm. Clinical judgment remains paramount. The model has not been externally validated and should not be used as a substitute for guideline-based decision making.
Reference:
Docherty K F, et al. Effect of Dapagliflozin, Compared With Placebo, According to Baseline Risk in DAPA-HF. Eur Heart J. 2022. doi:10.1016/j.jchf.2024.01.018.