Prospective Evaluation of Quality-of-Life Improvement After Dapagliflozin Initiation in a Greek Population With HFrEF: The EVOLUTION-HF 12-Month Results.
Potoupni V, Boulmpou A, et al. • Clinical cardiology • 2026
Significant improvements among all KCCQ-23 scores were observed from baseline to 12-months post dapagliflozin initiation, revealing that initiation and optimization of guideline-directed medical therapy in routine clinical practice provides improvement to quality of life over time.
Key Findings
Results
Dapagliflozin initiation in HFrEF patients was associated with significant improvements in all KCCQ-23 quality-of-life scores over 12 months.
The study enrolled 257 consecutive patients diagnosed with HFrEF who initiated dapagliflozin in a routine clinical setting in Greece.
Follow-up period lasted 12 months.
Improvements were observed across all KCCQ-23 domain scores from baseline to 12 months.
The study was observational, multi-center, and longitudinal in design.
Patient-reported outcomes were assessed using the Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23).
Results
Dapagliflozin was safe and well-tolerated throughout the 12-month observation period in this Greek HFrEF population.
257 consecutive patients were observed in a real-world routine clinical setting.
The study characterized treatment patterns including discontinuation timing and reasons for discontinuation.
Concomitant heart failure and glucose-lowering therapies were assessed over time.
Adherence to dapagliflozin was evaluated as a secondary objective.
No new safety signals were identified during the observation period.
Results
Patients aged over 65 years, with prior myocardial infarction, or recent hospitalizations showed a diminished quality-of-life response to dapagliflozin.
These subgroups were identified as higher-risk groups with attenuated benefit.
The finding underscores the need for tailored management and closer follow-up in these populations.
Although benefits were observed in most patients, the response was not uniform across all subgroups.
Prior myocardial infarction and recent hospitalizations were specific clinical characteristics associated with reduced QoL improvement.
Methods
The study population consisted of HFrEF patients defined by left ventricular ejection fraction ≤40% initiating dapagliflozin in routine clinical practice in Greece.
The study was an observational, multi-center, longitudinal cohort study.
257 consecutive patients were enrolled across multiple centers in Greece.
Patients were newly initiated on dapagliflozin as part of routine care, not a controlled trial.
The primary objectives included characterizing baseline demographic and clinical features and evaluating treatment patterns.
The study reflects real-world clinical practice rather than a controlled trial environment.
Background
SGLT2 inhibitors, including dapagliflozin, have emerged as cornerstone therapy for HFrEF, significantly reducing hospitalizations and mortality regardless of glycemic status, sex, race, or comorbidities.
HFrEF is defined by a left ventricular ejection fraction ≤40%.
HFrEF is associated with substantial morbidity, mortality, and impaired quality of life, particularly in patients with higher NYHA class.
The benefits of SGLT2 inhibitors in HFrEF are described as independent of glycemic status, sex, race, or comorbidities.
This background evidence informed the rationale for evaluating dapagliflozin in a Greek real-world population.
What This Means
This research studied 257 patients in Greece who had heart failure with reduced pumping ability (called HFrEF) and were starting a medication called dapagliflozin, which belongs to a class of drugs originally developed for diabetes but now widely used in heart failure. The researchers followed these patients for 12 months and measured how their quality of life changed using a validated heart failure questionnaire called the KCCQ-23, which captures patients' own reports of their symptoms, physical limitations, and overall wellbeing. They found that scores on all parts of this questionnaire improved significantly over the year, suggesting that adding dapagliflozin to standard heart failure treatment in everyday clinical practice leads to meaningful quality-of-life gains for most patients.
The medication was safe and well-tolerated throughout the study. However, not all patients benefited equally — those who were older than 65, had previously suffered a heart attack, or had been recently hospitalized for heart failure showed smaller improvements in quality of life compared to other patients. This suggests that these higher-risk groups may need more individualized care and closer monitoring when starting this medication.
This research suggests that dapagliflozin improves how heart failure patients feel in their daily lives when used in real-world clinical settings outside of controlled trials, reinforcing its role as an important part of standard heart failure treatment. The findings also highlight that certain patient characteristics — older age, history of heart attack, and recent hospitalization — may signal a need for more careful management to maximize the benefits of this therapy.
Potoupni V, Boulmpou A, Maragkoudakis S, Briasoulis A, Foukarakis E, Stavrati A, et al.. (2026). Prospective Evaluation of Quality-of-Life Improvement After Dapagliflozin Initiation in a Greek Population With HFrEF: The EVOLUTION-HF 12-Month Results.. Clinical cardiology. https://doi.org/10.1002/clc.70466