DELIVERing Progress in Heart Failure with Preserved Ejection Fraction

This editorial reviews findings from the DELIVER trial, which evaluated dapagliflozin an SGLT2 inhibitor in patients with mildly reduced or preserved left ventricular ejection fraction (LVEF). Building on EMPEROR-Preserved, the study enrolled 6263 patients across 20 countries to compare dapagliflozin with placebo for reducing cardiovascular death or worsening heart failure. Dapagliflozin significantly lowered the risk of the primary composite outcome across the overall cohort and multiple subgroups, including patients with LVEF ≥60%, elevated BMI, NYHA class III/IV symptoms, and those with previously reduced LVEF that recovered to >40%. The editorial highlights the growing population with improved LVEF and affirms that dapagliflozin provides benefit even in this group. It contrasts trial similarities and differences with EMPEROR-Preserved, notes limitations in trial diversity (e.g., low Black patient representation), and calls for mechanistic studies to explain SGLT2 inhibitor efficacy. The DELIVER trial reinforces SGLT2 inhibitors as disease-modifying agents in heart failure beyond glycemic control.

This editorial reviews findings from the DELIVER trial, which evaluated dapagliflozin an SGLT2 inhibitor in patients with mildly reduced or preserved left ventricular ejection fraction (LVEF). Building on EMPEROR-Preserved, the study enrolled 6263 patients across 20 countries to compare dapagliflozin with placebo for reducing cardiovascular death or worsening heart failure. Dapagliflozin significantly lowered the risk of the primary composite outcome across the overall cohort and multiple subgroups, including patients with LVEF ≥60%, elevated BMI, NYHA class III/IV symptoms, and those with previously reduced LVEF that recovered to >40%. The editorial highlights the growing population with improved LVEF and affirms that dapagliflozin provides benefit even in this group. It contrasts trial similarities and differences with EMPEROR-Preserved, notes limitations in trial diversity (e.g., low Black patient representation), and calls for mechanistic studies to explain SGLT2 inhibitor efficacy. The DELIVER trial reinforces SGLT2 inhibitors as disease-modifying agents in heart failure beyond glycemic control.