The Efficacy and Safety of Early Initiation of SGLT2 Inhibitor in Acute Decompensated Heart Failure: A Meta-Analysis

The safety and efficacy of sodium glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce mortality and heart failure (HF) hospitalisations in chronic HF. Recent studies have explored its early initiation in acute decompensated HF. This meta-analysis sought to evaluate the safety and efficacy of SGLT2 inhibitors in acute decompensated HF. PubMed and Embase databases were searched to identify randomised trials and propensity matched prospective and retrospective studies evaluating SGLT2 inhibitors in acute decompensated HF. Eight studies met inclusion criteria. Primary end points were all-cause death and HF readmissions. Secondary end points were adverse events including hypotension and acute kidney injury (AKI). A total of 9,154 patients were included. Early initiation of SGLT2 inhibitor in acute HF was associated with significant reduction in all-cause death (OR 0.70; 95% CI 0.60–0.82) and HF readmissions (OR 0.56; 95% CI 0.46–0.69) compared with standard medical therapy (Figure). SGLT2 inhibitor use was also associated with favourable 30-day diuretic response compared with control (weight loss 3.8–4.2 kg vs 1.0–3.0 kg, respectively). There were no differences in rate of hypotension (OR 1.06; 95% CI 0.87–1.29) or AKI (OR 0.79; 95% CI 0.51–1.23). Early initiation of SGLT2 inhibitors is safe and effective in acute decompensated HF, achieving increased diuresis and improved long-term prognosis.