The early initiation of sodium-glucose cotransporter-2 inhibitors in patients with decompensated heart failure: A systematic review and meta-analysis

INTRODUCTION: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown significant reduction in cardiovascular mortality and heart failure hospitalization in patients with chronic heart failure. Despite their benefits in chronic heart failure, their use during episodes of acute decompensation remains under investigation.

METHODS: A comprehensive literature search was performed using PubMed, Google Scholar, and ClinicalTrials.gov from database inception through September 3, 2025. The predefined endpoints were all-cause mortality, heart failure hospitalizations, and a composite of cardiovascular mortality or heart failure worsening. Outcomes were pooled using a random effects Mantel-Haenszel model. The DerSimonian and Laird method was used for estimation of τ.2 We reported effect sizes as risk ratios (RR) with 95 % confidence interval (CI).

RESULTS: A total of eight randomized controlled trials, encompassing 4,714 patients, were included in the analysis. Among patients hospitalized with decompensated heart failure, treatment with SGLT2 inhibitors compared with standard care only (control group) was associated with a significant decrease in all-cause mortality (RR 0.72; 95 % CI, 0.58-0.90; P < 0.01; I² = 0 %), and in the composite outcome of cardiovascular mortality or heart failure rehospitalization (RR 0.68; 95 % CI, 0.53-0.86; P < 0.01; I² = 28 %). However, no significant reduction was observed in heart failure rehospitalization as an isolated outcome (RR 0.92; 95 % CI, 0.82-1.03; P = 0.16; I² = 0 %).

CONCLUSION: SGLT-2 inhibitors during hospitalization for acute decompensated heart failure is effective and led to decrease in all-cause mortality and a composite endpoint of cardiovascular mortality or heart failure hospitalizations.