Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jan;30(1):89-101.
doi: 10.1007/s10741-024-10446-2. Epub 2024 Oct 15.

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

Muhammad Sameer Arshad  1 , Adeena Jamil  1 , Stephen J Greene  2   3 , Harriette G C Van Spall  4   5 , Gregg C Fonarow  6 , Javed Butler  7   8 , Muhammad Shahzeb Khan  9   10   11
Affiliations
Review

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

Muhammad Sameer Arshad et al. Heart Fail Rev. 2025 Jan.

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.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing Interests: Dr. Greene has received research support from the Duke University Department of Medicine Chair’s Research Award, American Heart Association, Amgen, AstraZeneca, Boehinger Ingelheim, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; has served on advisory boards or as consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Corcept Therapeutics, Corteria Pharmaceuticals, CSL Vifor, Cytokinetics, Eli Lilly, Lexicon, Merck, Novo Nordisk, Otsuka, Roche Diagnostics, Sanofi, scPharmaceuticals, Tricog Health, and Urovant Pharmaceuticals; and has received speaker fees from AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Lexicon, and Roche Diagnostics; Dr. Van Spall is funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada, and is a consultant to Bayer and Medtronic; Dr. Fonarow has received research funding from the National Institutes of Health and has received consulting fees from Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Edwards Lifesciences, Janssen, Medtronic, Merck, and Novartis; Dr. Butler is consultant to Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, Cardiocell, Cardior, CSL Bearing, CVRx, Cytokinetics, Daxor, Edwards, Element Science, Faraday, Foundry, G3P, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Levator, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Pulnovo, Regeneron, Renibus, Roche, Salamandra, Salubris, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vascular Dynamics, Vifor, and Zoll. Dr.Khan has received fees from Bayer; Dr. Arshad and Dr. Jamil have no relevant competing interests to disclose.

References

    1. Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, Januzzi J, Verma S, Tsutsui H, Brueckmann M, Jamal W, Kimura K, Schnee J, Zeller C, Cotton D, Bocchi E, Böhm M, Choi DJ, Chopra V et al (2020) Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 383(15):1413–1424. https://doi.org/10.1056/NEJMOA2022190/SUPPL_FILE/NEJMOA2022190_DATA-SHAR... - DOI - PubMed
    1. Fontes-Carvalho R, Santos-Ferreira D, Raz I, Marx N, Ruschitzka F, Cosentino F (2021) Protective effects of SGLT-2 inhibitors across the cardiorenal continuum: two faces of the same coin. Eur J Prev Cardiol. https://doi.org/10.1093/EURJPC/ZWAB034
    1. Butler J, Packer M, Siddiqi TJ, Böhm M, Brueckmann M, Januzzi JL, Verma S, Gergei I, Iwata T, Wanner C, Ferreira JP, Pocock SJ, Filippatos G, Anker SD, Zannad F (2023) Efficacy of empagliflozin in patients with heart failure across kidney risk categories. J Am Coll Cardiol 81(19):1902–1914. https://doi.org/10.1016/J.JACC.2023.03.390/SUPPL_FILE/MMC1.DOCX - DOI - PubMed
    1. Mcmurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Anand IS, Bělohlávek J, Böhm M, Chiang CE, Chopra VK, de Boer RA, Desai AS, Diez M, Drozdz J, Dukát A, Ge J et al (2019) Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 381(21):1995–2008. https://doi.org/10.1056/NEJMOA1911303 - DOI - PubMed
    1. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, Lewis JB, Riddle MC, Voors AA, Metra M, Lund LH, Komajda M, Testani JM, Wilcox CS, Ponikowski P, Lopes RD, Verma S, Lapuerta P, Pitt B (2021) Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med 384(2):117–128. https://doi.org/10.1056/NEJMOA2030183 - DOI - PubMed

MeSH terms

Substances

LinkOut - more resources