Early administration of SGLT2 inhibitors in hospitalized patients: A practical guidance from the current evidence

Abstract

Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent one of the main cornerstones of heart failure treatment. Nevertheless, while the cardiovascular beneficial effects of these drugs have been clearly demonstrated by several clinical trials, in clinical practice, it remains challenging to identify the appropriate timing to start SGLT2 inhibitors. The potential risk of side effects, like genito-urinary infections and interaction with other drugs, may often lead to delay the prescription of these drugs in the acute setting. However, several studies have demonstrated the safety and the prognostic impact of SGLT2 inhibitors in the hospitalized patient, suggesting that treatment initiation during hospitalization or early post-discharge may represent an ideal therapeutic option. In this review, we discuss the main trials on early administration of SGLT2 inhibitors in acute heart failure supporting early introduction of SGLT2 inhibitors to optimize heart failure treatment. The efficacy and safety of these drugs in patients with acute myocardial infarction are also discussed. Based on the review of existing evidences, a practical flowchart on early administration of SGLT2 inhibitors in the acute setting is proposed.

Keywords: Acute heart failure; Heart failure; SGLT2 inhibitors; Worsening heart failure.

Figure 1

Main benefits of early administration of SGLT2 inhibitors during hospitalization or shortly after discharge, for both acute heart failure and acute myocardial infarction.

Figure 2

Practical flowchart for a rapid in‐hospital SGLT2 inhibitors initiation.