Frailty was common and independently associated with worse outcomes after TAVI, and dapagliflozin appeared to confer greater relative benefit in patients with frailty.
Frailty was highly prevalent among patients in the DapaTAVI trial with a baseline frailty assessment.
Prefrail and frail patients had a higher risk of the primary composite outcome (all-cause death or worsening heart failure at 1 year) than robust patients.
Dapagliflozin was associated with a lower risk of the primary end point in frail patients but not in prefrail or robust patients.
The treatment effect of dapagliflozin differed significantly according to frailty status.
There was no evidence that frailty modified the safety profile of dapagliflozin.
This study re-analyzed data from the DapaTAVI trial, which tested the diabetes/heart-failure drug dapagliflozin in people who had undergone transcatheter aortic valve implantation (TAVI), a minimally invasive procedure to replace a narrowed heart valve. The researchers asked whether the drug's benefit differed depending on how frail patients were, using a simple five-item frailty questionnaire in 1222 patients. Almost half of patients (47.2%) were frail and another 40.3% were prefrail. Frail and prefrail patients were more likely to die or be hospitalized/worsen with heart failure within a year than robust patients. Dapagliflozin was linked to a lower risk of these outcomes in frail patients (about a 47% relative reduction), but no clear benefit was seen in prefrail or robust patients. The difference between groups was statistically significant, and the drug's safety did not appear to differ by frailty. This research suggests that frailty is a common and important marker of risk after TAVI and that dapagliflozin may be especially useful for frail patients. Because this was a post hoc analysis, and the robust group was small, the findings are hypothesis-generating and need confirmation in further studies.
Gonzalez-Manzanares R, Ojeda S, Amat-Santos I, Ariza-Solé A, Romaguera R, López Otero D, et al.. (2026). Dapagliflozin After Transcatheter Aortic Valve Implantation According to Frailty in DapaTAVI Trial.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.051379