Impact of early in-hospital SGLT2 inhibitor use on mortality in acute heart failure: a real-world cohort study
N Benameur, A Molina, B Elboussaadani, Z RaissuniAbstract
Introduction
Acute heart failure (AHF) remains associated with high in-hospital mortality (1). While sodium–glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in chronic heart failure, data on their initiation during hospitalisation for AHF and its impact on in-hospital mortality remain limited (2,3).
Purpose
This study evaluates the association between early in-hospital use of SGLT2 inhibitors and all-cause in-hospital mortality in a large cohort of patients admitted for AHF in a university hospital.
Methods
We conducted a retrospective cohort study of adults (≥18 years) admitted to the cardiac intensive care unit (ICU) for AHF, with or without acute coronary syndromes, between July 2023 and April 2025. Patients were categorised by in-hospital SGLT2 inhibitor use. Exclusion criteria included dialysis, renal or cardiac transplantation, eGFR <30 mL/min/1.73 m², cardiogenic shock, diabetic ketoacidosis, symptomatic hypotension, and early transfer. The primary outcome was all-cause in-hospital mortality. Baseline clinical, laboratory, ECG, echocardiographic, and therapeutic data were collected. Data were analysed using SPSS software.
Results
A total of 1,546 patients with acute heart failure were included (mean age 63.4 ± 15.1 years, 57.5% male, mean LVEF 44.4 ± 14.6%, mean eGFR 62.6 ± 40.1 mL/min/1.73 m²). SGLT2 inhibitors were initiated in 18.6% of patients. Overall, in-hospital mortality was 10.7%, with 7.3% in SGLT2i users versus 13.4% in non-users (p = 0.003). Mortality was significantly lower with SGLT2i in patients with mild renal impairment (p < 0.001), moderate renal impairment (p < 0.001), preserved FEVG (p < 0.001), moderately reduced FEVG (p < 0.001), dyslipidemia (p = 0.022), hypertension (p = 0.007), and atrial fibrillation (p = 0.006). No significant mortality reduction was observed in patients with severe renal dysfunction, hypotension, or major potassium disturbances.
Conclusion
In-hospital use of SGLT2 inhibitors in acute heart failure was associated with reduced all-cause mortality, supporting early initiation as part of guideline-directed medical therapy. Prospective studies are needed to confirm these findings.