The use of sglt-2 inhibitors in heart failure with preserved ejection fraction (hfpef): a bibliometric analysis

Background Sodium-glucose co-transporter-2 (SGLT-2) inhibitors initially emerged as glucose-lowering agents but are now foundational therapies for heart failure with preserved ejection fraction (HFpEF). Landmark trials established their prognostic benefits, reducing both hospitalizations and morbidity, representing the first consistent disease-modifying therapy for HFpEF. However, a systematic analysis of the literature underpinning the paradigm shift in SGLT-2-HFpEF research over time is lacking. Methods We searched Scopus for the 100 most-cited English-language original articles (January 2015–March 2025) on SGLT-2 inhibitors in HFpEF. Data extracted included citation counts, journals, authors, institutions, H-indices, and journal impact factors. Bibliometric analyses using Bibliometrix/Biblioshiny (R), VOSviewer, and CiteSpace examined bibliometric couplings, co-citation networks, keywords, and citation bursts. Results SGLT-2 inhibitor-HFpEF research sits firmly within the cardiology sphere, with nearly 90% of top-cited studies appearing in cardiology journals, most notably the European Journal of Heart Failure (EJHF), which alone accounts for 17%, alongside consistently high-impact contributions from New England Journal of Medicine (NEJM), which generated 4,936 citations despite publishing significantly fewer papers. What began as a diabetes-centred evidence base shaped by EMPA-REG OUTCOME and CANVAS gradually shifted toward broad heart-failure investigations, culminating in landmark HFpEF trials such as EMPEROR-Preserved and DELIVER. This momentum peaked in 2021–2022, a period marked by intense collaboration among 94 shared authors and a strong concentration of publications in NEJM, EJHF, and Circulation (66.7%). Within this interconnected landscape, author J. Butler emerges as a central figure, not only for his extensive output and citation count, with 5,372 citations, but also for his close intellectual partnership with S. D. Solomon (120 total co-citations), reflecting the influence of their respective teams leading the major HFpEF trials, reinforcing the governance of these trials on the direction of subsequent SGLT-2-HFpEF research. Much of this activity is rooted in large US research hubs, responsible for 71.5% of key articles. Across the literature, keyword mapping consistently positions HFpEF, empagliflozin, and demographic factors at its core. Conclusions Research on SGLT-2 inhibitors in HFpEF has rapidly progressed from metabolic outcome studies to large heart failure-specific trials, now translating into tangible improvements in patient outcomes. Our analysis highlights a small group of high-impact journals and institutions anchoring a highly collaborative global network of both established and emerging authors. Future priorities include generating longer-term outcome data, expanding geographic representation, and exploring combination strategies, such as pairing SGLT-2 inhibitors with GLP-1 receptor agonists.