The Impact of Early In-Hospital Use of SGLT2 Inhibitors on Outcomes in Patients With Acute Heart Failure: An Updated Systematic Review and Meta-Analysis.

Abstract

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, employed as antidiabetic agents, have been shown to effectively improve the prognosis of patients with chronic and stable heart failure, chronic kidney disease, and diabetes in the context of cardiovascular-renal-endocrine integrated management. However, the safety and clinical benefits of the early application of SGLT2 inhibitors in hospitalized patients with acute heart failure remain controversial. This study aimed to evaluate the safety and prognostic impact of early SGLT2 inhibitor therapy in patients with acute heart failure.

Methods: A systematic literature search of the PubMed, Web of Science, and Cochrane Library databases was conducted to identify studies on the use of SGLT2 inhibitors in acute heart failure. Two researchers independently screened studies, extracted data, and assessed the risk of bias in the included studies. The meta-analysis was performed using STATA 16.0 software (StataCorp, College Station, TX, USA).

Results: A total of 23 studies involving 47,291 patients with acute heart failure were included in this analysis (10 randomized controlled trials and 13 observational studies). Early use of SGLT2 inhibitors in hospitalized patients with acute heart failure was associated with a reduction in the incidence of composite events in the short term (relative risk (RR) = 0.64, 95% confidence interval (CI) (0.56, 0.74)), all-cause mortality (RR = 0.72, 95% CI (0.60, 0.86)), and heart failure rehospitalization rates (RR= 0.77, 95% CI (0.63, 0.87)); however, the early use of SGLT2i did not improve the incidence of cardiogenic death (RR = 0.74, 95% CI (0.51, 1.08)). Additionally, the early administration of SGLT2 inhibitors significantly reduced the incidence of cardiogenic mortality (RR = 0.77, 95% CI (0.60, 1.0); p = 0.045), as well as decreasing heart failure rehospitalization rates (RR = 0.77, 95% CI (0.70, 0.86)) and all-cause mortality (RR = 0.49, 95% CI (0.41, 0.60)), without increasing the incidence of adverse drug reactions such as acute kidney injury, urinary tract infections, diabetic ketoacidosis, hypoglycemia, or hypotension.

Conclusion: Early in-hospital use of SGLT2 inhibitors can safely and effectively reduce the incidence of all-cause mortality, cardiogenic rehospitalization, and composite events in acute heart failure patients in both the short term and over one year.