Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors for Acute Heart Failure: A Systematic Review

Abstract

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have recently drawn attention as a viable therapy for acute heart failure (AHF). Despite this, a comprehensive synthesis of current research has not been undertaken. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review evaluated eight studies involving 3,352 participants. The scope encompassed research from the last twenty years, focusing on the effectiveness of SGLT2 inhibitors in AHF management. Detailed considerations regarding the temporal context and heterogeneity were incorporated into the methodology. Results: The utilization of SGLT2 inhibitors yielded compelling results in improving cardiovascular outcomes, showcasing a substantial 58.2% reduction in major adverse cardiovascular events (MACE) and a noteworthy 15% decrease in NT-proBNP levels. Empagliflozin therapy, specifically, exhibited enhanced clinical efficacy, as indicated by a 48% improvement in the Kansas City Cardiomyopathy Questionnaire Total Symptom Score. Furthermore, a detailed analysis revealed that markers of acute kidney injury witnessed a significant reduction after the administration of empagliflozin. This reduction reached statistical significance after 3 days of treatment (P=0.02) and persisted through the 7-day assessment (P=0.003). This comprehensive exploration of the results provides a more nuanced understanding of the multifaceted benefits associated with SGLT2 inhibitors, particularly empagliflozin, in the management of acute heart failure. Conclusion: The current body of research strongly supports the application of SGLT2 inhibitors in managing AHF, emphasizing considerable improvements in clinical outcomes. Despite these positive findings, the abstract acknowledges the need for further research to determine the optimal timing, dosage, long-term safety of these inhibitors, and their effectiveness across diverse patient populations.