In-Hospital Initiation of SGLT2 Inhibitors in Patients with Acute Heart Failure: A Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis
Starting a diabetes drug during heart-failure hospitalization cuts death risk by 39% and serious worsening by 33%, offering an immediately adoptable treatment approach.
This meta-analysis of 8 RCTs (N=4,096) with median 60-day follow-up found that starting SGLT2 inhibitors during acute heart failure hospitalization significantly reduces all-cause mortality by 39% and worsening HF events by 33% without increasing adverse events. Trial Sequential Analysis confirmed firm evidence for mortality reduction, supporting a near-term implementable practice change in acute HF management.
What the study was
- Study design
- Systematic review and meta-analysis (8 RCTs); Trial Sequential Analysis
- Population
- Adults hospitalized with acute heart failure
- Sample size
- 4096
- Category
- Treatment Innovation
- Maturity
- Potentially Practice-Changing
- Journal
- Journal of Cardiac Failure
Why it surfaced
Meta-analysis of 8 RCTs (N=4,096) with TSA-confirmed mortality reduction provides highest-level evidence for in-hospital SGLT2i initiation in AHF. Co-authored by Fonarow/Mentz (top HF trialists). Addresses timing question for SGLT2i that is actionable immediately in clinical practice.
A plain-language summary of published research — not medical advice. Talk to a clinician about your own care.