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Lookup NU author(s): Dr Raheel Ahmed
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The Author(s). Background: Acute heart failure (AHF) remains a leading cause of hospitalization and mortality despite therapeutic advances. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have shown benefits in chronic HF, but their role when initiated during hospitalization for AHF remains uncertain. Methods: A literature search was conducted across main databases through September 10, 2025 to identify randomized controlled trials (RCTs) evaluating in-hospital initiation of SGLT2 inhibitors in patients with AHF. Primary outcomes were all-cause death and worsening HF. Secondary outcomes included cardiovascular death, HF rehospitalization, and safety endpoints. A random-effects model was used to estimate risk ratios (RRs) with 95% confidence intervals (CIs). Results: Eight RCTs including 4096 patients were analyzed with a weighted median follow-up of 60 days. In-hospital initiation of SGLT2 inhibitors significantly reduced all-cause death (RR, 0.61; 95% CI, 0.47–0.81) and worsening HF events (RR, 0.67; 95% CI, 0.48–0.94) compared with the control group. The risk of cardiovascular death was significantly lower with SGLT2 inhibitors (RR, 0.68; 95% CI, 0.47–0.99). No significant effect on HF rehospitalizations was observed (RR, 0.87; 95% CI, 0.70–1.09). Safety outcomes, including acute kidney injury, hypotension, hypoglycemia, urinary tract infection, and serious adverse events were comparable between groups. Trial sequential analysis confirmed firm evidence of mortality reduction, while further trials are needed for worsening HF. Conclusions: In-hospital initiation of SGLT2 inhibitors in patients with AHF lowers mortality and worsening HF without increasing adverse events. Further evidence from large-scale RCTs with longer follow-ups is required to reach a definitive conclusion.
Author(s): Ahmed M, Rana JS, Sajjad L, Zulfiqar E, Chandak V, Ain QT, Ahmed R, Mentz RJ, Fonarow GC
Publication type: Article
Publication status: Published
Journal: Journal of Cardiac Failure
Year: 2026
Pages: Epub ahead of print
Online publication date: 29/04/2026
Acceptance date: 12/04/2026
Date deposited: 01/06/2026
ISSN (print): 1071-9164
ISSN (electronic): 1532-8414
Publisher: Elsevier BV
URL: https://doi.org/10.1016/j.cardfail.2026.04.018
DOI: 10.1016/j.cardfail.2026.04.018
Data Access Statement: All data generated or analyzed during this study are included in this article. Further inquiries should be directed to the corresponding author.
PubMed id: 42067122
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