Key result
Early dapagliflozin or empagliflozin cuts in-hospital mortality ~42% vs placebo in acute heart failure.
Why the study?
The study was conducted to evaluate the efficacy and safety of early initiation of dapagliflozin and empagliflozin in acute heart failure.
Does early initiation of dapagliflozin and empagliflozin reduce mortality and worsening heart failure in patients with acute heart failure?
Meta-Analysis (n=1,417)
Does early initiation of dapagliflozin and empagliflozin reduce mortality and worsening heart failure in patients with acute heart failure?
Effect estimate: RR 0.58 (95% CI 0.36-0.91)
Absolute Event Rate: 4.6% vs 8.3%
p-value: p=0.02
Early initiation of SGLT2 inhibitors within five days of admission for acute heart failure significantly reduces in-hospital mortality and worsening heart failure without increasing adverse events.
Supports early SGLT2i initiation in acute HF; extends chronic HF benefits to the inpatient setting.
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have proven to significantly reduce mortality and rehospitalization in heart failure with reduced ejection fraction (HFrEF). Supported by the 2023 European Society of Cardiology (ESC) guidelines and the safety, tolerability, and efficacy of rapid optimization of heart failure (STRONG-HF) trial, SGLT2i offer improved outcomes with a favorable safety profile, emphasizing their pivotal role in HFrEF management. The aim of this study was to evaluate early initiation with dapagliflozin and empagliflozin, focusing on their efficacy and safety in acute heart failure (AHF). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven databases for randomized controlled trials on SGLT2i in AHF (2019-2024). Outcomes included all-cause mortality, heart failure (HF)-related events, all-cause rehospitalization, length of hospital stay, diuretic response, serum electrolytes, and adverse events (AEs). The Cochrane Risk of Bias 2 tool was used. Data were analyzed using a random-effects model and presented as standardized mean differences and risk ratios with 95% confidence intervals. A subgroup analysis was conducted based on intervention. Nine studies encompassing 1,417 patients with a generally low risk of bias were included. Initiating SGLT2i within five days of admission significantly reduced in-hospital all-cause mortality risk by 42% and in-hospital worsening HF during rehospitalization by 39%. SGLT2i also significantly reduced serious AEs risk by 27%. No significant differences were found in other outcomes, including specific AEs (acute kidney injury, hepatic injury, symptomatic hypotension, hypoglycemia, urinary tract infections, and diabetic ketoacidosis). The analysis showed homogeneity, with no significant differences between SGLT2i. The study highlights that initiating SGLT2i within five days of admission significantly reduces all-cause mortality and worsening HF during rehospitalization, with a better safety profile than placebo.
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Immanuel et al. (2025) conducted a meta-analysis in Acute heart failure (n=1,417). Dapagliflozin and Empagliflozin vs. Placebo was evaluated on In-hospital all-cause mortality (RR 0.58, 95% CI 0.36-0.91, p=0.02). Initiating dapagliflozin or empagliflozin within five days of admission significantly reduced in-hospital all-cause mortality by 42% (RR 0.58) compared to placebo in patients with acute heart failure.
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