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Real-world Experience and Trends of Initiating Sodium-Glucose Cotransporter 2 Inhibitors among Hospitalized Patients

Saleh Sharif1, Emran El Ukbi2, Herschel Horowitz2

  • 1Department of Internal Medicine C, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Department of Cardiology Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.

The Israel Medical Association Journal : IMAJ
|July 23, 2025
PubMed
Abstract

Insights

Initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors during hospitalization for acute heart failure (HF) is safe. New SGLT2 inhibitor users experienced lower 2-year mortality and rehospitalization rates compared to controls.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Guidelines now support sodium-glucose cotransporter 2 (SGLT2) inhibitor use in heart failure (HF) with reduced ejection fraction (HFrEF) since 2021 and preserved ejection fraction (HFpEF) since 2023.
  • Historically, initiating oral antidiabetic therapy during hospitalization was not recommended.

Purpose of the Study:

  • To evaluate the safety and effectiveness of starting SGLT2 inhibitors during acute heart failure (HF) hospitalization.
  • To compare outcomes between new SGLT2 inhibitor initiators, chronic users, and controls.

Main Methods:

  • A historical cohort study included 307 patients hospitalized with acute HF from October 2018 to April 2022.
  • Patients were categorized into three groups: chronic SGLT2 inhibitor users, new initiators during hospitalization, and controls not receiving SGLT2 inhibitors.

Main Results:

  • New SGLT2 inhibitor initiators showed the lowest 2-year mortality (22.2%) and 1-year rehospitalization rates (18.3%).
  • In-hospital mortality was 3.6%, with 2-year mortality at 37.7% overall.
  • Adverse events, primarily acute kidney injury, occurred in 15.6% of SGLT2 inhibitor users.

Conclusions:

  • Initiating SGLT2 inhibitors during hospitalization for acute heart failure (HF) is a safe strategy.
  • This approach is linked to decreased post-discharge mortality and reduced hospital readmissions.

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