Eficácia da Dapagliflozina no tratamento da insuficiência cardíaca com fração de ejeção reduzida: revisão sistemática e meta-análise de ensaios clínicos randomizados

Abstract

Heart failure with reduced ejection fraction (HFrEF) remains associated with high morbidity and mortality, frequent hospitalisations, and significant impairment of quality of life. In this setting, dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, has demonstrated relevant cardiovascular benefits, irrespective of the presence of diabetes mellitus. This study aimed to evaluate the efficacy of dapagliflozin in patients with HFrEF. This is a systematic review and meta-analysis of randomised controlled trials (RCTs). The search was conducted across the PubMed/MEDLINE, Cochrane CENTRAL, Embase, Scopus, ICTRP, and LILACS databases. RCTs published between 2015 and 2026 were exclusively included, with no language restrictions. Seven RCTs involving adult patients with HFrEF treated with dapagliflozin in combination with standard care were selected. In this study, a significant reduction was observed in cardiovascular mortality (risk ratio [RR]: 0.83; 95% CI: 0.71–0.97) and heart failure hospitalisations (RR: 0.79; 95% CI: 0.64–0.96). Significant reductions were also noted in NT-proBNP levels, with a mean difference of -258.50 pg/mL (95% CI: -401.91 to -115.09), systolic blood pressure, with a mean difference of -2.29 mmHg (95% CI: -3.37 to -1.21), and body weight, with a mean difference of -1.89 kg (95% CI: -2.54 to -1.23). Furthermore, there was a significant improvement in quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). No statistically significant differences were observed in left ventricular ejection fraction and peak oxygen consumption (peak VO₂). Dapagliflozin provided clinical benefits in patients with HFrEF, reducing major cardiovascular outcomes and improving haemodynamic parameters and quality of life. These findings reinforce its role as an important prognosis-modifying therapy in the contemporary management of HFrEF.