DELIVER-HF Dapagliflozin Benefit Calculator
- DELIVER-HF Dapagliflozin Benefit Calculator: Explanation and Clinical Context
The calculator estimates the 2-year absolute benefit of adding dapagliflozin 10 mg once daily in patients with symptomatic heart failure with left ventricular ejection fraction (LVEF) > 40% (mildly reduced or preserved). The estimate uses a simplified model based on the primary endpoint of the DELIVER trial (composite of cardiovascular death or worsening heart failure) in which dapagliflozin reduced the primary outcome with a hazard ratio of approximately 0.82 compared with placebo.
This tool adjusts the baseline 2-year risk by surrogate markers such as NT-proBNP, eGFR, and NYHA class, to individualize the calculation. It then applies the treatment hazard ratio to derive an estimated absolute risk reduction (ARR) and number needed to treat (NNT) over 2 years.
Clinical significance: The DELIVER trial demonstrated that in patients with heart failure and LVEF > 40%, dapagliflozin significantly reduced the risk of cardiovascular death or worsening heart failure (event rate ~16.4% vs ~19.5% in placebo over ~2.3 yrs) across subgroups including those with and without diabetes.
Interpretation: A higher calculated baseline risk (e.g., very elevated NT-proBNP, severe renal dysfunction, higher NYHA class) leads to greater estimated absolute benefit from therapy. Lower baseline risk results in smaller absolute benefit. The NNT gives a pragmatic number: how many patients would need treatment over ~2 years to avoid one event.
Reference:
Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022;387:1089-98. doi:10.1056/NEJMoa2206286.
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