In-hospital initiation of sodium-glucose co-transporter-2 inhibitors in patients with acute heart failure

Muhammad Sameer Arshad; Adeena Jamil; Stephen J Greene; Harriette G C Van Spall; Gregg C Fonarow; Javed Butler; Muhammad Shahzeb Khan

doi:10.1007/s10741-024-10446-2

In-hospital initiation of sodium-glucose co-transporter-2 inhibitors in patients with acute heart failure

Heart Fail Rev. 2024 Oct 15. doi: 10.1007/s10741-024-10446-2. Online ahead of print.

Authors

Muhammad Sameer Arshad¹, Adeena Jamil¹, Stephen J Greene^{2

3}, Harriette G C Van Spall^{4

5}, Gregg C Fonarow⁶, Javed Butler^{7

8}, Muhammad Shahzeb Khan^{9

10

11}

Affiliations

¹ Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
² Duke Clinical Research Institute, Durham, NC, USA.
³ Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
⁴ Faculty of Health Science, McMaster University, Hamilton, Canada Population Health Research Institute, Hamilton, Canada.
⁵ Baim Institute of Clinical Research, Boston, USA.
⁶ Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA, USA.
⁷ Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
⁸ Baylor Scott and White Research Institute, Dallas, TX, USA.
⁹ Baylor Scott and White Research Institute, Dallas, TX, USA. shahzebkhan@gmail.com.
¹⁰ The Heart Hospital Plano, Plano, TX, USA. shahzebkhan@gmail.com.
¹¹ Department of Medicine, Baylor College of Medicine, Temple, TX, USA. shahzebkhan@gmail.com.

PMID: 39404914
DOI: 10.1007/s10741-024-10446-2

Abstract

Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiovascular and kidney benefits to patients with heart failure (HF) and/or chronic kidney disease (CKD), regardless of diabetes status and left ventricular ejection fraction (LVEF). Despite robust data demonstrating the efficacy of SGLT-2 inhibitors in both ambulatory and hospital settings, real-world evidence suggests slow and varied adoption of SGLT2 inhibitors among patients hospitalized for HF. Barriers to implementation of SGLT2i may include clinicians' concerns regarding potential adverse events such as diabetic ketoacidosis (DKA), volume depletion, and symptomatic hypoglycemia; or concerns regarding physiologically expected reductions in eGFR. Guidelines lack specific, practical safety data and definitive recommendations regarding in-hospital initiation and continuation of SGLT2i in patients hospitalized with HF. In this review, we discuss the safety of in-hospital SGLT2 inhibitor initiation based on recent trials and highlight the clinical implications of their early use in patients hospitalized for HF.

Keywords: Acute heart failure; Adverse events; Diabetic ketoacidosis; Genital yeast infections; In-hospital initiation; Sodium-glucose cotransporter-2 inhibitors.

Publication types

Review