Breakthrough daily diabetes tablet to treat all British heart failure sufferers secures NHS approval
- Dapagliflozin was only available for certain kinds of heart failure but now for all
All British heart failure sufferers will now be eligible for a breakthrough daily tablet that dramatically reduces symptoms and boosts survival chances.
The drug, called dapagliflozin, was previously only available to NHS patients with one of the three types of heart failure – representing roughly half of the million people in the UK living with the incurable condition.
But drug watchdog the National Institute for Health and Care Excellence (NICE) ruled last week that those with the other two kinds of heart failure should also be offered the £244-a-year medication, if their doctors think it will be of benefit.
Until now, many of these patients had relatively few treatment options and often faced a bleak prognosis. But dapagliflozin has been shown in trials to slow down decline in this group by about a fifth and cut the risk of death by 18 per cent.
Some patients taking the drug have been saved from needing a heart transplant – with experts branding the drug’s extended approval by NICE ‘a turning point’.
‘Until now, there’s been an absence of treatments that reduce mortality for many heart failure patients,’ says John McMurray, professor of medical cardiology at the University of Glasgow, who led the trials.
Unlike a heart attack, which happens when the blood supply to the heart is suddenly blocked, heart failure is a chronic condition in which the heart can no longer pump effectively because the muscle has become weakened.
Symptoms, including debilitating fatigue and breathlessness, can suddenly worsen, which is why heart failure causes about 86,000 emergency hospital admissions every year.
Triggers include heart attacks, high blood pressure and viral infections, and about half of those with heart failure die within five years of a diagnosis.
Although heart disease can occur at any age, it’s most common in older people. The number of Britons affected has been steadily rising over the decades due to a combination of an ageing population and more people surviving heart attacks. An increasing number of patients living with diabetes and high blood pressure, which in turn raise the risk of heart failure, is also a factor.
There are three main types of heart failure. With the first, the main chamber of the heart is working at ten per cent or more below its normal capacity. This is called heart failure with reduced ejection fraction, or HFrEF – a term that relates to the amount of blood squeezed out from the heart. The second type – heart failure with mildly reduced ejection fraction, or HFmrEF – means the heart is operating at anywhere between one and ten per cent below its normal function.
The third – heart failure with preserved ejection fraction, or HFpEF – means the heart is struggling to fill with blood properly.
In January 2021, health chiefs gave dapagliflozin the go-ahead for reduced ejection fraction patients following trials that showed those taking the drug were a third less likely to require an urgent hospital admission.
At the time of the approval, Prof McMurray said: ‘We can’t cure heart failure yet, but in some cases we can now put the condition into complete remission using a combination of drugs, including dapagliflozin, and save some sufferers progressing to the point that they need a heart transplant.
‘There are other drugs similar to dapagliflozin that we now know work, too, and more are coming down the line. We’re chipping away at this disease.’
The decision to approve the drug for the other two types of heart failure follows the results of an international trial that found taking the pill for two years was equally beneficial for patients with mildly reduced or preserved ejection fraction disease.
The drug is in a class of medicines called sodium-glucose co-transporter-2 (SGLT2) inhibitors. They help diabetics by flushing excess glucose out of the body in the urine.
Experts don’t fully understand why they have such a powerful effect on heart failure – one suggestion is that they reduce the amount of work the organ has to do to pump blood around the body.
Importantly, patients in trials were found to experience few, if any, side effects.
Speaking about the drug’s approval, Nick Hartshorne-Evans, chief executive of heart failure charity Pumping Marvellous, said: ‘For a condition that’s physically debilitating and severely limits an individual’s quality of life, this is a critical step in treating people living with the disease.
‘We hope today’s decision can be a catalyst for the long-overdue prioritisation of care for all types of heart failure in the UK.’