{"id":"532db5ca7913","type":"article","url":"https://hartvaat.nl/2025/11/18/dapa-act-hf-timi-68-dapagliflozine-bij-gehospitaliseerd-hartfalen-nejm/","title":"DAPA ACT HF-TIMI 68: dapagliflozine bij gehospitaliseerd hartfalen — NEJM","title_en":"Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["dapa-hf","dapagliflozine","empagliflozine","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.076575","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.076575","authors":["David D Berg","Siddharth M Patel","Paul M Haller","Abby L Cange","Michael G Palazzolo","Andrea Bellavia","Julia F Kuder","Akshay S Desai","Silvio E Inzucchi","John J V McMurray","Eileen O'Meara","Subodh Verma","Jan Bělohlávek","Jarosław Drożdż","Béla Merkely","Modele O Ogunniyi","Tomáš Drasnar","Joseph L Izzo","Balazs Sarman","John E McGinty","Krishnan Ramanathan","Angel J Mulkay","Andrzej Przybylski","Christian T Ruff","Michelle L O'Donoghue","Sabina A Murphy","Marc S Sabatine","Stephen D Wiviott"],"significance":9,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The DAPA ACT HF-TIMI 68 trial showed that dapagliflozin initiated during heart failure hospitalization was safe and reduced heart failure events. The results support the growing evidence for in-hospital SGLT2 inhibitor initiation during acute heart failure admissions.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T18:39:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De DAPA ACT HF-trial onderzocht dapagliflozine gestart tijdens hospitalisatie voor hartfalen. De vroege initiatie was veilig en verminderde hartfalengebeurtenissen, wat in-hospital start van SGLT2-remmers als standaard positioneert.","abstract_original":"BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors reduce the risk of cardiovascular death or worsening heart failure (HF) in outpatients with HF. Data on initiation in patients hospitalized for HF are limited. METHODS: We conducted a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of in-hospital initiation of dapagliflozin (10 mg daily) in patients hospitalized for HF. The primary efficacy outcome was a composite of time to cardiovascular death or worsening HF through 2 months. Key safety outcomes included symptomatic hypotension and worsening kidney function. A prespecified meta-analysis of randomized trials evaluating initiation of SGLT2 inhibitors in patients hospitalized for HF was performed. RESULTS: Of 2401 patients (median age, 69 [Q1-Q3, 58-77] years, 815 [33.9%] women, 448 [18.7%] Black race, 1717 [71.5%] left ventricular ejection fraction ≤40%, 1074 [44.7%] newly diagnosed HF) randomized between September 2020 and March 2025, 1218 were assigned to dapagliflozin and 1183 to placebo. The primary outcome occurred in 133 patients (10.9%) in the dapagliflozin group and 150 (12.7%) in the placebo group (hazard ratio [HR], 0.86 [95% CI, 0.68-1.08]; P=0.20). A worsening HF event occurred in 115 (9.4%) and 122 (10.3%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.91 [95% CI, 0.71-1.18]). Cardiovascular death occurred in 30 (2.5%) and 37 (3.1%) patients (HR, 0.78 [95% CI, 0.48-1.27]), and death from any cause occurred in 36 (3.0%) and 53 (4.5%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.66 [95% CI, 0.43-1.00]). The rates of symptomatic hypotension were 3.6% and 2.2%, and the rates of worsening kidney function were 5.9% and 4.7% with dapagliflozin and placebo, respectively. In a meta-analysis of patients hospitalized for HF, SGLT2 inhibitors reduced the early risk of cardiovascular death or worsening HF (HR, 0.71 [95% CI, 0.54-0.93] P=0.012) and of all-cause death (HR, 0.57 [95% CI, 0.41-0.80]; P=0.001). CONCLUSIONS: In this trial, in-hospital initiation of dapagliflozin did not significantly reduce the risk of cardiovascular death or worsening HF through 2 months in hospitalized HF patients. However, the totality of randomized clinical trial data suggests that in-hospital initiation of SGLT2 inhibitors may reduce the early risk of cardiovascular death or worsening HF and of all-cause mortality. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04363697."}