Supportive Evidence for Starting SGLT2 Inhibitors in Hospitalized Heart Failure Patients

Recent research suggests that initiating SGLT2 inhibitors, such as dapagliflozin, during hospitalization for heart failure (HF) may be beneficial, although current data show mixed results. A study presented at ESC Congress 2025 and published in Circulation evaluated the safety and efficacy of starting dapagliflozin in hospitalized HF patients. The trial involved 2,401 participants across multiple countries, all hospitalized with a primary diagnosis of HF and elevated natriuretic peptides. Participants were randomized to receive dapagliflozin or placebo shortly after stabilization, with the primary focus on reducing cardiovascular death and worsening HF within the first two months. Results demonstrated that while the primary composite outcome was not significantly reduced with dapagliflozin (10.9% vs. 12.7%), there was a notable reduction in all-cause mortality (3.0% vs. 4.5%). Additionally, a meta-analysis combining data from similar trials with other SGLT2 inhibitors indicated a significant reduction in early cardiovascular death, worsening HF, and overall mortality—highlighting the potential benefits of early in-hospital therapy. Experts conclude that although the primary endpoint was not met, the overall evidence indicates that starting SGLT2 inhibitors during hospitalization for HF can be a safe and potentially effective strategy to improve patient outcomes.