Related Experiment Videos
SGLT2 Inhibitor Use and Outcomes in Patients with Acute Heart Failure and Low Body Mass Index
Yusuke Uemura1, Toru Kondo2, Yuta Ozaki1
1Cardiovascular Center, Anjo Kosei Hospital.
International Heart Journal
|July 15, 2026
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are underused in heart failure (HF) patients with low body mass index (BMI). However, low BMI did not increase SGLT2i discontinuation or adverse events, suggesting it shouldn't deter their use.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are beneficial for heart failure (HF) patients across various body mass indices (BMIs).
- Concerns exist regarding the safety and efficacy of SGLT2is in patients with very low BMIs.
Purpose of the Study:
- To investigate the utilization, tolerability, and clinical outcomes of SGLT2 inhibitors in acute heart failure patients with low body mass index.
Main Methods:
- Retrospective evaluation of 621 acute heart failure patients hospitalized between 2021-2023.
- Low BMI defined by age-specific thresholds (<18.5 kg/m² for <70 years, <20 kg/m² for ≥70 years).
- Assessed SGLT2i prescription, 1-year discontinuation rates, and clinical outcomes (cardiovascular death, HF readmission, all-cause mortality) using time-to-event analysis and inverse probability of treatment weighting (IPTW).
Main Results:
- 29.0% of patients had low BMI; SGLT2is were prescribed less frequently in this group (22.1% vs. 41.5%).
- 1-year discontinuation-free rates were similar between BMI groups (0.880).
- Crude analyses showed benefits in non-low BMI (cardiovascular events) and low BMI (mortality) groups; however, IPTW adjustment attenuated the mortality benefit in the low BMI group.
Conclusions:
- SGLT2 inhibitors are underutilized in acute heart failure patients with low BMI.
- Low BMI alone is not associated with increased SGLT2i discontinuation or adverse outcomes.
- Low BMI should not be a barrier to initiating or continuing SGLT2 inhibitors in acute heart failure management.
Related Concept Videos
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:22Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
01:28Mitral Regurgitation IV: Nursing Management
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
01:30Heart Failure VII: Nursing Interventions
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
01:30Heart Failure IV: Classification and Diagnostic Evaluation
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...