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Which Patients with Heart Failure Benefit from an SGLT2 Inhibitor?

Joseph Benjamen1,2, Michael Fralick1,2

  • 1Department of Medicine, Division of General Internal Medicine, Sinai Health, Toronto, ON.

NEJM Evidence
|July 22, 2025
PubMed

Insights

Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce heart failure events and cardiovascular death in adults. Despite a strong recommendation, their adoption into clinical practice remains slow.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown efficacy in reducing heart failure events and cardiovascular mortality.
  • Evidence supports their use in adults with heart failure, irrespective of diabetes status.
  • A class 1A indication exists for SGLT2 inhibitors in heart failure management.

Purpose of the Study:

  • To review the benefits and risks of SGLT2 inhibitors for adults with heart failure.
  • To discuss pivotal clinical trials that established the efficacy of SGLT2 inhibitors.
  • To provide practical prescribing information and identify areas of ongoing research.

Main Methods:

  • Review of randomized controlled trials (RCTs) demonstrating the cardiovascular benefits of SGLT2 inhibitors.
  • Analysis of clinical guidelines and practice adoption data.
  • Synthesis of information on drug benefits, risks, and clinical application.

Main Results:

  • SGLT2 inhibitors significantly reduce the composite of heart failure events and cardiovascular death.
  • The benefits are observed across patient populations, including those without type 2 diabetes mellitus.
  • Despite proven efficacy and strong recommendations, clinical uptake of SGLT2 inhibitors for heart failure is lagging.

Conclusions:

  • SGLT2 inhibitors are a vital therapeutic option for adults with heart failure.
  • Addressing barriers to adoption is crucial to maximize patient benefit.
  • Further research is needed to clarify remaining uncertainties regarding SGLT2 inhibitor use.

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