SGLT2 Inhibitors for Acute Heart Failure Decrease Risk for Rehospitalization

Person with chest pain
3d rendered illustration of a man with chest pain.
A meta-analysis was conducted to determine the efficacy and safety of administering sodium-glucose cotransporter 2 inhibitors to patients hospitalized for AHF.

Patients hospitalized with acute heart failure (AHF) who initiated sodium-glucose cotransporter 2 (SGLT2) inhibitor use were found, in a systematic review and meta-analysis, to have a reduced risk for rehospitalization due to heart failure (HF) and improved patient-reported outcomes. These findings were published in Cardiovascular Diabetology.

Investigators from the University of Arkansas for Medical Sciences and Duke University searched publication databases through November 2021 for studies of SGLT2 inhibitors in the AHF setting.

The trials which met the inclusion criteria were the EMPA-RESPONSE-AHF study ( identifier: NCT03200860) of empagliflozin published in 2020, the SOLOIST-WHF trial ( identifier: NCT03521934) of sotagliflozin published in 2020, and the EMPULSE trial ( identifier: NCT04157751) of empagliflozin published in 2021. All studies had a low risk for bias on all 5 examined domains.

The studies comprised a total of 1831 patients with a median follow-up duration of 9 months. Approximately 50% of patients received SGLT2 inhibitors. Patient cohorts were aged mean 69 to 76 years, 33% to 34% were women, and 93.3% to 100% were White or ethnicity was not reported.

Patients who received SGLT2 inhibitors were at decreased risk for rehospitalization for HF (odds ratio [OR], 0.52; 95% CI, 0.42-0.65; I2, 0%). In addition, these patients were associated with improved Kansas City Cardiomyopathy Questionnaire scores at 90 days or 4 months (mean difference [MD], 4.12; 95% CI, 1.89-6.53; I2, 0%).

There was no effect observed for SGLT2 inhibitors on all-cause mortality (OR, 0.70; 95% CI, 0.46-1.08; I2, 18%), risk for acute kidney infection (OR, 0.76; 95% CI, 0.50-1.16; I2, 10%), hypotension (OR, 1.17; 95% CI, 0.80-1.71; I2, 0%), or hypoglycemia (OR, 1.51; 95% CI, 0.86-2.65; I2, 0%).

This study was limited by using published summary data and not individual-based assessments.

“Initiation of SGLT2 inhibitors in patients hospitalized for AHF before discharge or shortly after (within 3 days of discharge) resulted in a reduction in the risk of rehospitalization and improved patient-reported outcomes with no apparent increase in the risk of adverse effects,” the study authors wrote.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Salah HM, Al’Aref SJ, Khan MS, et al. Efficacy and safety of sodium‑glucose cotransporter 2 inhibitors initiation in patients with acute heart failure, with and without type 2 diabetes: a systematic review and meta‑analysis. Cardiovasc Diabetol. Published online February 5, 2022. doi:10.1186/s12933-022-01455-2