Early introduction of SGLT2 inhibitors in patients with Heart Failure reduced ejection fraction hospitalized for acute heart failure: Results from Real-world observations

Introduction The early introduction of SGLT2 inhibitors during acute heart failure was studied in the empulse trial with positive results, but limited reel-world data are currently available. Objective Assessing the efficacy of early introducing of ISGLT2 during the acute heart failure. Method We prospectively analyzed patients admitted for acute heart failure with an ejection fraction of less than 40%. We excluded patients with glomerular filtration rate (GFR) < 20 ml/min, cardiogenic shock, and ejection fraction > 40%. We studied all-cause mortality as the primary outcome, and as secondary outcomes the duration of decongestion and pro-BNP levels at discharge. Results We included 516 patients who met the inclusion criteria. Early introduction of ISGLT2 was adopted in 270 patients (52.8%). No differences were observed in mean age (ISGLT vs. standard car;65.89 vs 65.58 years; P = 0.129), female gender (38.9% vs. 38.2%; P = 0.473), diabetes (48.1% vs. 51.6%; P = 0.242) and hypertension (44.4% vs. 45.5%; P = 0.437). At admission, Ejection fraction was higher in the ISGLT2 group (34% vs. 32%; P = 0.033), and systolic pulmonary pressure was lower (37.4mmhg vs. 41.5mmhg; P < 0.001).GFR was higher in the ISGLT2 group (72 vs 64 ml/min; P = 0.005), with lower Pro-BNP levels in this group but without significant difference (7635 vs 9839 ng/ml; P = 0.063). Over a mean follow-up of 22 months, the primary endpoint was observed in 95 patients (18.4%), with significantly higher mortality in the standard group (28.5% vs. 9.3%; P < 0.001). After multivariate adjusted Cox proportional hazards analysis, early introduction of ISGLT2 was independently associated with a 23% reduction in all-cause mortality with (HR: 0. 862; 95%CI; 0.444–0.902; P = 0.039), as well as a significant difference on Kaplein meirer survival analysis (Log-rank test P < 0.001) ( Fig. 1 ). For the secondary endpoints, the introduction of ISGLT2 significantly reduced the duration of decongestion (6.25 days in vs. 7.37 days; P = 0.017; with a mean reduction of 1.17 days). ISGLT2 also significantly reduced Pro-BNP levels at discharge (3986 vs. 7029 ng/ml; P = 0.001). Conclusion The results of our study support the hypothesis that SGLT2 should not only be introduced in HFrEF patients, but should also be rapidly introduced even during acute heart failure.