Design, Setting, and Participants: This post hoc analysis used data from 2 phase 3 randomized clinical trials conducted in 26 countries, DAPA-HF (left ventricular ejection fraction [LVEF] ≤40%) and DELIVER (LVEF >40%). Patients with New York Heart Association functional class II through IV and elevated levels of N-terminal pro-
B-type natriuretic peptide were eligible. Data were analyzed between September 2022 and December 2022.
Intervention: The primary outcome was the composite of worsening HF or cardiovascular death.
Results: Among 11 005 patients for whom
gout history was available, 1117 patients (10.1%) had a history of
gout. The prevalence of
gout was 10.3% (488 of 4747 patients) and 10.1% (629 of 6258 patients) in those with an LVEF up to 40% and greater than 40%, respectively. Patients with
gout were more often men (897 of 1117 [80.3%]) than those without (6252 of 9888 [63.2%]). The mean (SD) age was similar between groups, 69.6 (9.8) years for patients with
gout and 69.3 (10.6) years for those without. Patients with a history of
gout had a higher body mass index, more comorbidity, and lower estimated glomerular filtration rate and were more often treated with a loop
diuretic. The primary outcome occurred at a rate of 14.7 per 100 person-years (95% CI, 13.0-16.5) in participants with
gout compared with 10.5 per 100 person-years (95% CI, 10.1-11.0) in those without (adjusted hazard ratio [HR], 1.15; 95% CI, 1.01-1.31). A history of
gout was also associated with a higher risk of the other outcomes examined. Compared with placebo,
dapagliflozin reduced the risk of the primary end point to the same extent in patients with (HR, 0.84; 95% CI, 0.66-1.06) and without a history of
gout (HR, 0.79; 95% CI, 0.71-0.87; P = .66 for interaction). The effect of
dapagliflozin use with other outcomes was consistent in participants with and without
gout. Initiation of
uric acid-lowering
therapy (HR, 0.43; 95% CI, 0.34-0.53) and
colchicine (HR, 0.54; 95% CI, 0.37-0.80) was reduced by
dapagliflozin compared with placebo.
Conclusions and Relevance: This post hoc analysis of 2 trials found that
gout was common in HF and associated with worse outcomes. The benefit of
dapagliflozin was consistent in patients with and without
gout.
Dapagliflozin reduced the initiation of new treatments for
hyperuricemia and
gout.
Trial Registration: ClinicalTrials.gov Identifiers: NCT03036124 and NCT03619213.