SGLT2 Inhibitors for the Prevention and Treatment of Heart Failure: A Scientific Statement of the HFA and the HFAI
In the 2021 European Society of Cardiology (ESC) heart failure (HF) guidelines, sodium-glucose cotransporter 2 (SGLT2) inhibitors were recommended for the prevention of HF in patients with type 2 diabetes mellitus (T2DM) and for the treatment of HF with reduced ejection fraction (HFrEF). Further trials showed efficacy of empagliflozin and dapagliflozin in patients with HF with preserved ejection fraction (HFpEF). These results prompted a broadened recommendation for the SGLT2 inhibitors dapagliflozin or empagliflozin across the whole left ventricular ejection fraction (LVEF) spectrum in the 2023 Focused Update of the ESC HF guidelines and in other international guidelines. In SOLOIST-WHF and EMPULSE, sotagliflozin (enrolling only patients with T2DM) and empagliflozin, respectively, were beneficial when initiated at the end or soon after an episode of decompensated HF. Based on these results and on the early appearance of their beneficial effects, the administration of SGLT2 inhibitors should start early in patients hospitalized for acute HF. Analyses after study drug withdrawal in randomized clinical trials have shown that their benefits may decline rapidly after discontinuation, and thus, persistence of treatment is advised. In EMPACT-MI, empagliflozin did not reduce the primary outcome of cardiovascular (CV) death/HF hospitalization but reduced first/recurrent HF hospitalizations. Potential benefits of SGLT2 inhibitors in further specific conditions (i.e., cardiac amyloidosis, grown-up congenital heart disease and paediatric patients with HF) have been reported in observational studies but need confirmation from prospective trials. This scientific statement summarizes current evidence regarding the effects of SGLT2 inhibitors for the prevention and treatment of HF.
Authors
- Stefan D. Anker (ORCID: https://orcid.org/0000-0002-0805-8683)
- Mark C. Petrie (ORCID: https://orcid.org/0000-0002-6333-9496)
- Finn Gustafsson (ORCID: https://orcid.org/0000-0003-2144-341X)
- Michael Böehm (ORCID: https://orcid.org/0000-0003-4897-6953)
- Gianluigi Savarese (ORCID: https://orcid.org/0000-0001-7732-0887)
- Antoni Bayes-genis A (ORCID: https://orcid.org/0000-0002-3044-197X)
- Piotr Ponikowski (ORCID: https://orcid.org/0000-0002-3391-7064)
- Amina Rakisheva (ORCID: https://orcid.org/0000-0001-9842-962X)
- Gerasimos S Filippatos (ORCID: https://orcid.org/0000-0002-5640-0332)
- Maurizio Volterrani (ORCID: https://orcid.org/0000-0002-2624-9213)
- François Roubille (ORCID: https://orcid.org/0000-0002-5288-9687)
- Andrew J.S. Coats (ORCID: https://orcid.org/0000-0002-2771-4260)
- Marco Metra (ORCID: https://orcid.org/0000-0001-6691-8568)
- Daniela Tomasoni (ORCID: https://orcid.org/0000-0002-7584-2857)
- Ovidiu Chioncel (ORCID: https://orcid.org/0000-0002-3197-3628)
- Giuseppe Rosano (ORCID: https://orcid.org/0000-0002-6868-4248)
- Marianna Adamo (ORCID: https://orcid.org/0000-0002-3855-1815)
- Ewa A. Jankowska (ORCID: https://orcid.org/0000-0002-9202-432X)
- Vijay Chopra (ORCID: https://orcid.org/0000-0001-9512-1718)
- Petar Seferović (ORCID: https://orcid.org/0000-0002-1955-4199)
- Juan Carlos Kaski (ORCID: https://orcid.org/0000-0001-8068-0189)
- Javed Butler (ORCID: https://orcid.org/0000-0003-4267-6933)
- Arsen Ristić (ORCID: https://orcid.org/0000-0002-0713-1180)
- Brenda Moura
- Peter van der Meer
- Offer Amir
Institutions
- Medanta The Medicity (IN)
- Centre National de la Recherche Scientifique (FR)
- University Medical Center Groningen (NL)
- Serbian Academy of Sciences and Arts (RS)
- Vita-Salute San Raffaele University (IT)
- Inserm (FR)
- Carol Davila University of Medicine and Pharmacy (RO)
- St George's, University of London (GB)
- University of Groningen (NL)
- Hebrew University of Jerusalem (IL)
- Université de Montpellier (FR)
- National and Kapodistrian University of Athens (GR)
- Hadassah Medical Center (IL)
- The Heart Research Institute (AU)
- Copenhagen University Hospital (DK)
- Rigshospitalet (DK)
- University Medical Center (US)
- Karolinska Institutet (SE)
- San Raffaele University of Rome (IT)
- University of Mississippi (US)
- Wroclaw Medical University (PL)
- University of Belgrade (RS)
- Universitätsklinikum des Saarlandes (DE)
- Stockholm South General Hospital (SE)
- Surgical Specialties (Canada) (CA)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Administração Regional de Saúde de Lisboa e Vale do Tejo (PT)
- Baylor Medical Center at Garland (US)
- Kazakh Institute of Oncology and Radiology (KZ)
- German Centre for Cardiovascular Research (DE)
- IRCCS Ospedale San Raffaele (IT)
- Centro de Estudos em Psicologia da Saúde (BR)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Hospital Universitari Germans Trias i Pujol (ES)
- Centro Hospitalar do Porto (PT)
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT)
- University of Glasgow (GB)
- University of Brescia (IT)
- Saarland University (DE)
Publication Details
- Journal
- ESC Heart Failure
- Published
- 2025-09-19
- DOI
- https://doi.org/10.1002/ehf2.15408
- Citations
- 2
- Primary Topic
- Diabetes Treatment and Management
- Type
- article
- Field-Weighted Citation Impact
- 2.59
Funders
- Defense Acquisition Program Administration