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Dapagliflozin improves heart failure (HF) and limits cardiovascular-related death in patients with HF with reduced ejection fraction (HFrEF), but does frailty modify its effectiveness? In a post hoc analysis of an industry-sponsored clinical trial (NEJM JW Gen Med Dec 15 2019 and N Engl J Med 2019; 381:1995), investigators calculated a frailty index (i.e., ratio of deficits present to the total number of deficits considered; index range, 0–1) in 4742 participants with symptomatic HF, ejection fraction of ≤40%, and elevated natriuretic peptide; patients had been randomized to dapagliflozin (10 mg daily) or placebo.
Half of patients were not frail (frailty index, <0.21), 34% were “more frail” (frailty index, 0.21–0.31), and 16% were “most frai…