Safety and Tolerability of SGLT2 Inhibitors in HFrEF: A Prospective Study in a Tropical Climate

Background: Heart failure with reduced ejection fraction (HFrEF) is a chronic condition with high morbidity and mortality. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are emerging as a foundational therapy in HFrEF. However, real-world data on their safety and tolerability in tropical climates remain limited. Objective: This study aimed to evaluate the safety and tolerability of SGLT2 inhibitors among HFrEF patients in Karachi, Pakistan, a city with a hot and humid climate. Methods: We conducted a prospective cohort study on 100 patients with HFrEF who were taking SGLT2 inhibitors for at least three months. Adverse effects were recorded using standardized questionnaires and clinical evaluations. Results: The mean patient age was 56 ± 13 years, with 54% male. Overall, 34% of patients reported side effects. The most frequent were postural hypotension and urinary tract infections (13% each), followed by dehydration (10%). Rehospitalization due to worsening heart failure symptoms occurred in 26% of patients during the study period. Despite these adverse effects, 88% of patients remained compliant with treatment. Conclusion: SGLT2 inhibitors are generally safe and well-tolerated among HFrEF patients in warm, humid climates when used with proactive monitoring. Our findings support their integration into treatment protocols for this patient population.