Current landscape and future potential of sodium-glucose cotransporter 2 inhibitors in heart failure: A systematic review and bibliometric analysis

Context: Despite extensive trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors in heart failure (HF), comprehensive analyses identifying emerging themes and knowledge gaps remain limited. Aims: To explore evolving areas and identify knowledge gaps on SGLT2 inhibitors in HF. Methods: A hybrid methodology was adopted. Bibliometric analysis using Scopus (as of May 12, 2025) was conducted with Biblioshiny and VOSviewer to assess research output, key contributors, and thematic trends. A subsequent systematic review, conducted using PubMed, Scopus, and ScienceDirect, was conducted for each identified trend, and the quality was assessed using the ROBINS-I and RoB 2.0 tools. Meta-analysis was performed using RStudio. Results: A total of 621 studies were included in the bibliometric analysis. Emerging themes included “ertugliflozin,” “acute heart failure,” and “fibrosis.” Six studies on ertugliflozin indicate promising results, although clinical outcomes such as HF rehospitalization and cardiovascular mortality remain unexamined. Fifteen studies assessing SGLT2 inhibitors in acute heart failure (AHF) suggested that early initiation may be clinically beneficial, with notable improvements in diuretic efficacy, diuretic response, symptom relief, and a reduced risk of composite outcomes [HR: 0.64; 95% CI: 0.47–0.86; p = 0.003], without significant adverse events. Studies assessing the effects of SGLT2 inhibitors on myocardial fibrosis have demonstrated a greater reduction in extracellular volume at 6 months [MD: −1.48; 95% CI: −1.71 to −1.25; p