Publications by authors named "Anna M Langkilde"
Article Synopsis
- Wearable accelerometers provide a way to continuously monitor physical activity in patients with heart failure, which could be useful for assessing treatment effects.
- In the DETERMINE trials, a subgroup of patients wore accelerometers at different points while also completing questionnaires and walking tests to evaluate their functional status.
- Results showed that lower activity levels were associated with worse health scores and measures, but overall, the relationships between accelerometer data and health assessments were generally weak, suggesting accelerometers could offer additional insights beyond traditional methods.
Background And Aims: Individuals with heart failure (HF), other forms of cardiovascular disease, or kidney disease are at increased risk for the development and adverse health effects of diabetes. As such, prevention or delay of diabetes is an important treatment priority in these groups. The aim of this meta-analysis was to determine the effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on incident diabetes in HF across the spectrum of left ventricular ejection fraction (LVEF) and across the broader spectrum of cardiovascular or kidney disease.
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- Albuminuria is a significant marker for kidney and cardiovascular problems in chronic kidney disease (CKD), and this study analyzed its impact on health outcomes in CKD patients receiving dapagliflozin or placebo.
- A post-hoc analysis of the DAPA-CKD trial involved 4,304 patients and found that dapagliflozin significantly decreased urinary albumin-to-creatinine ratio (UACR) after four months, with a 36% reduction in those with diabetes and 21% in those without.
- The study concluded that greater reductions in albuminuria were linked to lower risks of serious kidney and cardiovascular events, providing evidence for the benefits of dapagliflozin in managing CKD.
Article Synopsis
- Wearable accelerometers can measure physical activity levels and provide additional insights into how heart failure therapies, like dapagliflozin, impact patients' functional limitations.
- In a study involving heart failure patients, accelerometers were worn to track various activity metrics during trial phases, focusing on changes from baseline to week 16.
- Results showed that dapagliflozin positively influenced the number of steps and time spent in moderate-to-vigorous activity, though it did not enhance the 6-minute walk test distance, highlighting the usefulness of accelerometer data for assessing everyday physical activity.
Introduction: Despite the provision of renin-angiotensin-aldosterone-system inhibitors and immunosuppressive therapies, membranous nephropathy often progresses to end-stage kidney disease (ESKD). The objective of this prespecified analysis was to assess the safety and efficacy of dapagliflozin in patients with membranous nephropathy enrolled in the DAPA-CKD trial.
Methods: Patients with an estimated glomerular filtration rate (eGFR) of 25-75 mL/min/1.
Effect of dapagliflozin in patients with diabetes and heart failure with mildly reduced or preserved ejection fraction according to background glucose-lowering therapy: A pre-specified analysis of the DELIVER trial.
Eur J Heart Fail
July 2024
Aims: Type 2 diabetes (T2D) and heart failure (HF) frequently coexist, but whether clinical outcomes and treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) vary in relation to background glucose-lowering therapy (GLT) in this population is uncertain.
Methods And Results: DELIVER randomized patients with HF and left ventricular ejection fraction (LVEF) >40% to dapagliflozin or placebo. The primary outcome was a composite of worsening HF (HF hospitalization or urgent HF visit) or cardiovascular death.
Background: Higher temperatures are associated with higher rates of hospital admissions for nephrolithiasis and acute kidney injury. Occupational heat stress is also a risk factor for kidney dysfunction in resource-poor settings. It is unclear whether ambient heat exposure is associated with loss of kidney function in patients with established chronic kidney disease.
View Article and Find Full Text PDFAims: Patients with heart failure (HF) and history of myocardial infarction (MI) face a higher risk of disease progression and clinical events. Whether sodium-glucose cotransporter 2 inhibitors may modify clinical trajectory in such individuals remains incompletely understood.
Methods And Results: The DAPA-HF and DELIVER trials compared dapagliflozin with placebo in patients with symptomatic HF with left ventricular ejection fraction (LVEF) ≤40% and > 40%, respectively.
Article Synopsis
- The DELIVER trial studied the impact of dapagliflozin on patients with heart failure, focusing on differences between those in Asia and those elsewhere.
- It found that Asian participants had different health characteristics – being less likely to have conditions like diabetes and hypertension, yet they showed similar risks for worsening heart failure outcomes as those from outside Asia.
- The medication dapagliflozin effectively reduced the risk of cardiovascular death or worsening heart failure for both groups and was generally well tolerated, with similar rates of serious side effects and drug discontinuation across regions.
Background And Aims: Sodium-glucose cotransporter 2 inhibitors decrease blood pressure in patients with type 2 diabetes, but the consistency and magnitude of blood pressure lowering with dapagliflozin in patients with chronic kidney disease (CKD) is unknown. We conducted a prespecified analysis of the DAPA-CKD trial to investigate the effect of dapagliflozin on systolic blood pressure (SBP) in patients with CKD, with and without type 2 diabetes.
Methods: A total of 4304 adults with baseline estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.
BACKGROUND: The primary end point in most heart failure (HF) trials is a composite of time to a first worsening HF event or cardiovascular death. Prevention of recurrent events and improvements in symptoms/quality of life are also important for patients but are usually analyzed separately. Win statistics can integrate all these outcomes into a single composite end point, which is analyzed in hierarchical order, reflecting the clinical importance of each component.
View Article and Find Full Text PDFBACKGROUND: In patients with acute myocardial infarction (MI), therapies that could further reduce the risk of adverse cardiovascular and metabolic outcomes are needed. METHODS: In this international registry-based, randomized, double-blind trial, patients without prior diabetes or chronic heart failure, presenting with acute MI and impaired left ventricular systolic function, were randomly assigned 10 mg of dapagliflozin or placebo, given once daily. The primary outcome was the hierarchical composite of death, hospitalization for heart failure, nonfatal MI, atrial fibrillation/flutter, type 2 diabetes mellitus, New York Heart Association Functional Classification at the last visit, and body weight decrease of 5% or greater at the last visit using the win ratio analysis method.
View Article and Find Full Text PDFBACKGROUND: In the DAPA-CKD (Dapagliflozin in Patients with Chronic Kidney Disease) trial, dapagliflozin improved kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) with or without type 2 diabetes (T2D). In this post hoc analysis of DAPA-CKD, we assessed the effects of dapagliflozin on the correction and prevention of anemia. METHODS: The DAPA-CKD trial randomized patients (1:1) with an estimated glomerular filtration rate of 25 to 75 ml/min/1.
View Article and Find Full Text PDFBackground: Sleep apnea is more common in patients with heart failure (HF) than in the general population, but little is known about its association with clinical outcomes in various HF phenotypes or how it might modify the effect of HF therapy.
Objectives: To examine the prevalence of sleep apnea, its association with outcomes and the effects of dapagliflozin in patients with HF with and without sleep apnea in a pooled analysis of 2 trials comparing dapagliflozin to placebo in HFrEF (DAPA-HF trial) and HFmrEF/HFpEF (DELIVER trial).
Methods: A history of sleep apnea was investigator-reported.
Background: The sodium-glucose cotransporter type 2 inhibitor dapagliflozin reduces the risk of progressive kidney disease and cardiovascular events in patients with chronic kidney disease, with and without type 2 diabetes. Whether its effects are uniform across the spectrum of age and among men and women is unknown.
Objective: We performed a pre-specified analysis in DAPA-CKD to evaluate efficacy and safety of dapagliflozin according to baseline age and sex.
Article Synopsis
- * The study involved randomizing patients to receive either dapagliflozin, a combination of dapagliflozin and saxagliptin, or a placebo, and measuring various blood and urinary markers over 24 weeks.
- * Results showed that dapagliflozin significantly increased hemoglobin and decreased ferritin levels, as well as lowered urinary inflammation markers, indicating potential benefits for iron metabolism and reducing inflammation.
Decline in Estimated Glomerular Filtration Rate After Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Secondary Analysis of the DELIVER Randomized Clinical Trial.
JAMA Cardiol
February 2024
Importance: An initial decline in estimated glomerular filtration rate (eGFR) is expected after initiating a sodium-glucose cotransporter-2 inhibitor (SGLT2i) and has been observed across patients with diabetes, chronic kidney disease, and heart failure.
Objective: To examine the implications of initial changes in eGFR among patients with heart failure with mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) enrolled in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial.
Design, Setting, And Participants: This was a prespecified analysis of the results of the DELIVER randomized clinical trial, which was an international multicenter study of patients with EF greater than 40% and eGFR greater than or equal to 25.
Aim: COVID-19 may affect clinical risk in patients with heart failure. DELIVER began before and was conducted during the COVID-19 pandemic. This study aimed to evaluate the association between COVID-19 and clinical outcomes among DELIVER participants.
View Article and Find Full Text PDFBackground: Although beta-blockers are not recommended for the treatment of heart failure with preserved ejection fraction (HFpEF) according to the latest European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, these therapies remain commonly used for comorbidity management. There has been concern that beta-blockers may adversely influence clinical outcomes by limiting chronotropic response in HFpEF.
Objectives: This study sought to examine the contemporary use and implications of beta-blockers in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF.
Article Synopsis
- Therapies are needed to prevent heart failure and other cardiovascular problems after a recent heart attack.
- DAPA-MI is a major clinical trial testing the drug dapagliflozin versus a placebo in patients with heart attack and poor heart function, focusing on outcomes like death and hospitalization for heart failure.
- The trial aims to improve patient outcomes using an innovative design that leverages existing national clinical registries for efficient data collection and patient recruitment.
Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are guideline recommended in the management of heart failure (HF). Although these therapies can be initiated even in patients with comorbid chronic kidney disease, some patients may face deterioration of kidney function over time.
Objectives: In this study, the authors sought to examine the safety and efficacy of continuing SGLT2 inhibitors in HF when the estimated glomerular filtration rate (eGFR) falls below thresholds for initiation.
Background: Hospitalization is recognized as a sentinel event in the disease trajectory of patients with heart failure (HF), but not all patients experiencing clinical decompensation are ultimately hospitalized. Outpatient intensification of diuretics is common in response to symptoms of worsening HF, yet its prognostic and clinical relevance, specifically for patients with HF with mildly reduced or preserved ejection fraction, is uncertain.
Methods: In this prespecified analysis of the DELIVER trial (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we assessed the association between various nonfatal worsening HF events (those requiring hospitalization, urgent outpatient visits requiring intravenous HF therapies, and outpatient oral diuretic intensification) and rates of subsequent mortality.
Background: Because clinical characteristics and prognosis vary by geographic region in patients with heart failure (HF), the response to treatment may also vary. A previous report suggested that the efficacy of sodium-glucose cotransporter-2 inhibitor efficacy in heart failure with reduced ejection fraction (HFrEF) may be modified by region.
Objectives: The goal of this study was to examine the efficacy and safety of dapagliflozin in patients with HF according to geographic region.
Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease Across the Spectrum of Frailty.
J Gerontol A Biol Sci Med Sci
February 2024
Background: A sizeable proportion of patients with chronic kidney disease (CKD) are reported to be frail. Here we examined the safety and efficacy of dapagliflozin in patients with CKD by frailty level.
Methods: Adults with CKD, with/without type 2 diabetes, with an estimated glomerular filtration rate (eGFR) of 25-75 mL/min/1.