Key result
SGLT2 inhibitors improve HF survival globally, but severe access gaps persist in sub-Saharan Africa.
Why the study?
SGLT2 inhibitors have proven benefits in heart failure globally, but their implementation and trial data in sub-Saharan Africa remain limited and uncertain.
Do SGLT2 inhibitors improve clinical outcomes in heart failure, and what is the extent of their implementation and trial representation in sub-Saharan Africa?
Do SGLT2 inhibitors improve clinical outcomes in heart failure, and what is the extent of their implementation and trial representation in sub-Saharan Africa?
While global trials overwhelmingly support the efficacy and safety of SGLT2 inhibitors for heart failure, critical implementation barriers and a near absence of trial representation (<1%) severely restrict access to these therapies in sub-Saharan Africa.
Confirms global SGLT2 inhibitor benefits in heart failure; leaves open the need for sub-Saharan African trials and access strategies.
Background. Heart failure (HF) is a leading cause of morbidity and mortality in sub-Saharan Africa (SSA), where patients often present at a younger age and with more advanced disease than in high-income countries. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated significant benefits in reducing HF hospitalisations and mortality in large global trials. However, their implementation in SSA remains uncertain, with little region-specific trial data. Methods. A scoping review was conducted in accordance with PRISMA-ScR and JBI guidelines. PubMed, Scopus, Web of Science and Google Scholar were searched for clinical trials of SGLT2 inhibitors in HF published between 2015 and 2024. Eligible studies were randomised or interventional trials in adults (≥18 years). Data were extracted on study design, outcomes, safety and relevance to SSA. Results. Seven major HF-specific clinical trials were identified: DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, DELIVER, SOLOIST-WHF, EMPULSE and CHIEF-HF. Across these studies, SGLT2 inhibitors consistently reduced HF hospitalisations, improved survival in HF with reduced ejection fraction and improved patient-reported outcomes. Safety profiles were favourable, with adverse events similar to placebo, and serious complications rare. No trial was conducted exclusively in SSA, and African participation was minimal, mostly confined to South African sites. Limited real-world data suggest that uptake of SGLT2 inhibitors in SSA remains low, hindered by high cost, limited availability and low prescriber familiarity. Conclusion. Strong global trial evidence supports SGLT2 inhibitors as effective and safe therapies for HF, but their implementation in SSA is constrained by a lack of local trial data and significant access barriers. Addressing affordability, supply and clinician awareness is essential to translate global evidence into regional practice. Further SSA-specific research and policy interventions are urgently needed to close this gap.
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S Pillay (2026) conducted a review in Heart failure (n=23,000). SGLT2 inhibitors vs. Placebo was evaluated on Heart failure hospitalisations and survival. SGLT2 inhibitors consistently reduced heart failure hospitalisations and improved survival in global trials, but their use in sub-Saharan Africa is severely limited by major access and evidence gaps.
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