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SGLT2-is in Acute Heart Failure
Matteo Bianco1,2, Concetta Di Nora1,3, Renata De Maria1,4
1Area Scompenso Cardiaco, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), 50121 Firenze, Italy.
Journal of Clinical Medicine
|November 13, 2025
Summary
The optimal timing for initiating SGLT2 inhibitors in acute heart failure remains debated. Current guidelines suggest early use, but evidence from recent trials provides mixed results on mortality benefits.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Evidence supports SGLT2 inhibitors for chronic heart failure.
- Their role in early-stage acute heart failure is less clear.
- Guidelines offer conflicting advice on initiation timing.
Purpose of the Study:
- To review current evidence on SGLT2 inhibitor use in early acute heart failure.
- To analyze the pathophysiological rationale for their early application.
Main Methods:
- Review of European Society of Cardiology and American College of Cardiology guidelines.
- Analysis of data from EMPULSE, SOLOIST-WHF, and DAPA ACT HF-TIMI 68 trials.
Main Results:
- ESC guidelines advocate SGLT2 inhibitors in acute phases but lack specific timing.
- ACC consensus supports early initiation regardless of ejection fraction.
- DAPA ACT HF-TIMI 68 showed no reduction in mortality or hospitalizations at 2 months.
Conclusions:
- SGLT2 inhibitors show promise in early acute heart failure, with ACC supporting in-hospital initiation.
- Further research is needed to clarify optimal timing and long-term benefits.
- The pathophysiological rationale for early use warrants practical consideration.
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