CATEGORY: HEART & CIRCULATION
A new heart valve at 82 is meant to be a fresh start. Too often, heart failure circles back within the year. In a Spanish trial of 1,222 patients who had just had an aortic valve replaced through a leg artery, a procedure called TAVI, adding the pill dapagliflozin cut the risk of dying or sliding into worsening heart failure by 28% over one year, 15.0% versus 20.1%.1
A Trial Run in the Ninth Decade of Life
Trials rarely look like a cardiology waiting room. This one did. Median age was 82, nearly three quarters of participants were past 80, and 7% were past 90. All had heart failure before their valve procedure plus at least one other high-risk condition, such as weakened pumping function or reduced kidney function. Fewer than half had diabetes, the disease dapagliflozin was originally designed for. After a successful valve replacement at one of 39 hospitals, a computer randomly split them: usual care alone, or usual care plus a daily 10 mg tablet. The design was open, so everyone knew who was taking the pill. The events being counted, death and worsening heart failure, leave less room for wishful reading than symptom scores do.
Fewer Flare-Ups, a Few More Nuisances
The difference was driven by heart failure itself. Worsening episodes struck 9.4% of the dapagliflozin group versus 14.4% on usual care alone. Deaths from any cause were close: 7.8% versus 8.9%.1 The pill exacted its usual price. Genital infections, a known effect of a drug that works by sending excess sugar and fluid out through the urine, occurred in 1.8% versus 0.5%, and low blood pressure in 6.6% versus 3.6%. None of that erased the overall benefit.
The Question the Heart Failure Trials Left Open
This drug class had already earned its place in heart failure treatment. But people in their late 80s fresh from a valve procedure barely appeared in those earlier trials, so whether the benefit carried over was a genuine unknown. The investigators designed DapaTAVI to find out, and the answer was yes.1 It’s a result with reach beyond one procedure. Valve replacement through an artery is now routine for older adults, and this is among the first hard evidence about what should happen in the vulnerable year after it.
Key Takeaways
- Among mostly 80-and-older patients who added dapagliflozin after TAVI valve replacement, 15.0% died or developed worsening heart failure within a year, versus 20.1% with usual care alone, and the gap came mainly from fewer heart failure flare-ups.
- The trade-offs were genital infections and low blood pressure, both more common on the pill; the trial was open-label, meaning participants knew their treatment, though the outcomes counted were deaths and heart failure events rather than subjective ratings.
References
- Raposeiras-Roubín S, et al, for the DapaTAVI Investigators. Dapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation. N Engl J Med. 2025;392(14):1396–1405. link