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Published on: June 11, 2012

Glucose cotransporter-2 inhibitors on mortality and hospitalization in heart failure patients: a comprehensive

Xiang Mao1, Wenhua Liu1, Bingqian Hu2

  • 1Cardiovascular Medicine Department, Taizhou First People's Hospital, Taizhou, Zhejiang, China.

Frontiers in Endocrinology
|May 29, 2026
PubMed

Insights

Sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduce mortality and heart failure hospitalizations. These SGLT2 inhibitors improve cardiac function and biomarkers, regardless of diabetes status or heart failure type.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure (HF) presents a substantial global health burden with high hospitalization and mortality rates.
  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors, initially for diabetes, show significant cardiovascular and renal benefits in diverse patient groups.

Purpose of the Study:

  • To evaluate the impact of SGLT2 inhibitors on all-cause mortality and HF hospitalizations.
  • To assess secondary outcomes including NT-proBNP levels, left ventricular (LV) systolic function, and diuretic efficiency.
  • To analyze these effects in HF patients irrespective of ejection fraction or diabetes status.

Main Methods:

  • Systematic review and meta-analysis following PRISMA 2020 guidelines.
  • Searched major databases for randomized controlled trials (RCTs) published between January 2017 and November 2025.
  • Included 15 RCTs with 28,484 participants, using random-effects modeling and assessing heterogeneity and publication bias.

Main Results:

  • SGLT2 inhibitors reduced all-cause mortality by 14% (HR=0.86) and HF hospitalizations by 26% (HR=0.74).
  • Significant improvements observed in NT-proBNP levels (mean difference -168.4 pg/mL) and LV systolic function (LVEF +3.8%).
  • Diuretic efficiency increased by 480 mL/day, with consistent benefits across subgroups and no detected publication bias.

Conclusions:

  • SGLT2 inhibitors markedly decrease mortality and hospitalizations in heart failure patients.
  • Benefits on biomarkers and cardiac function are independent of diabetes status or HF phenotype, indicating a class effect.
  • SGLT2 inhibitors are supported as foundational therapy for heart failure across all ejection fraction categories.
Abstract

Keywords:
HFpEFHFrEFdapagliflozinempagliflozinheart failurehospitalizationleft ventricular functionmeta-analysis

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