Dapagliflozin at Discharge on Hospital Heart Failure Readmission

Exclusion Criteria

• •1. Age \< 18 or \> 90 years
• •2. Subjects with a history of type 1 diabetes
• •3. Treatment with thiazolidinediones (TZDs) or SGLT2-i during the past 3 months of admission
• •4. Recurrent episodes of severe hypoglycemia or hypoglycemic unawareness
• •5. History of recurrent HF admissions considered to be due to non-compliance (evaluated by the research staff for participation)
• •6. Patients with clinically significant hepatic disease (cirrhosis, jaundice, end-stage liver disease, portal hypertension) and elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \> 3 times upper limit of normal
• •7. Patients with impaired renal function (GFR \< 25 ml/min)
• •8. Mental condition rendering the subject unable to understand the nature, scope, and possible consequences of the study
• •9. Patients on ventricular assist devices (VADs)
• •10. History of heart transplant or listed for heart transplant
• •11. History of cardiac surgery (within 90 days prior to enrollment) or planned cardiac interventions within the following 6 months, including percutaneous coronary intervention (PCI), ablation, cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD)
• •12. HF due to restrictive/infiltrative cardiomyopathy, active myocarditis, constrictive pericarditis, severe stenotic valvular diseases, hypertrophic cardiomyopathy, or congenital heart disease
• •13. History of SGLT2-i allergy
• •14. Systolic blood pressure \< 100 mmHg
• •15. Uncontrolled hypertension, defined as a systolic blood pressure \> 200 mmHg at randomization
• •16. Female subjects who are pregnant or breast-feeding at time of enrollment into the study
• •17. Females of childbearing potential who are not using adequate contraceptive methods
• •18. In hospice or expected life expectancy less than 6 months
• •19. Patients with diabetic foot infection, osteomyelitis and history of amputation of lower extremities within 6 months of admission
• •20. Patients anticipated to undergo major surgical procedures during the following 6 months
• •21. Patients with active hematuria, urinary tract infection (UTI), or history of frequent UTIs or genital mycotic infections
• •22. Uncontrolled atrial fibrillation or atrial flutter with a resting heart rate \>110bpm documented by ECG at randomization
• •23. Any condition that in the opinion of the investigator would contraindicate the assessment of distance walked in 6 minutes (6MWD)
• •24. Chronic pulmonary disease, i.e. with known forced expiratory volume in the first second (FEV1) \<50% requiring home oxygen, or oral steroid therapy or current hospitalization for severe chronic obstructive pulmonary disease (COPD) thought to be a primary contributor to dyspnea, or significant chronic pulmonary disease in the Investigator's opinion, or primary pulmonary arterial hypertension
• •25. Patients with active history of bladder cancer
• •26. Patients with previous history of diabetic ketoacidosis, per American Diabetes Association (ADA) criteria