"In-Hospital Initiation of SGLT-2 Inhibitors in Acute Heart Failure: A Systematic Review and Meta-Analysis of Clinical, Decongestion, and Safety Outcomes".
Hafiz M Ahmed, Ubaid Ur Rehman, Muhammad Owais
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In 30 seconds
This systematic review and meta-analysis pooled 18 randomised controlled trials involving 15,560 adults hospitalised with acute heart failure, comparing in-hospital initiation of SGLT-2 inhibitors with placebo or standard care. Initiation was associated with fewer heart-failure worsening events or hospitalisations (RR 0.77, 95% CI 0.67-0.88; NNT = 48) and modest improvements in quality of life and decongestion measures. No increase was detected in the reported safety outcomes. The apparent reduction in all-cause mortality was less robust after adjustment for potential publication bias, and the authors call for further long-term confirmatory data.
Key findings
- Heart-failure worsening or hospitalisation was reduced (RR 0.77, 95% CI 0.67-0.88; NNT = 48).
- Quality of life improved (KCCQ-12 MD + 2.88 points, p = 0.01).
- Decongestion measures favoured SGLT-2 inhibitors: diuretic efficiency (SMD 0.52, p = 0.001), weight loss (MD - 0.94 kg, p < 0.001), and NT-proBNP (MD - 313.6 pg/mL, p = 0.04).
- No increase was detected in AKI, hypotension, hypoglycemia, ketoacidosis, genitourinary infections, or other serious adverse events.
Why it matters
Starting SGLT-2 inhibitors during an acute heart-failure admission may offer clinical benefit alongside improvements in decongestion, without a detected increase in the safety events assessed. The pooled randomised evidence is relevant to decisions about treatment timing, but the mortality signal is uncertain and the authors identify a need for longer-term confirmation.
What to keep in mind
The authors note that further long-term confirmatory data are needed. The all-cause mortality reduction showed potential publication bias and was attenuated in trim-and-fill analysis.