ESC 2025: Starting SGLT2 inhibitors in hospital may benefit heart failure patients

In-hospital initiation of dapagliflozin didn’t significantly reduce CV death or worsening heart failure (HF) over 2 months in the DAPA ACT HF-TIMI 68 trial, but a broader analysis suggests early benefits, according to findings presented at the European Society of Cardiology Congress 2025.

The randomized, placebo-controlled trial enrolled 2,401 patients hospitalized for HF, with dapagliflozin started a median of 3.6 days after admission. The primary outcome of CV death or worsening HF occurred in 10.9% of the dapagliflozin group vs. 12.7% with placebo (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.68 to 1.08; p=0.20). However, a prespecified meta-analysis of three trials, including empagliflozin and sotagliflozin, showed significant reductions in early CV death or worsening HF (HR 0.71; 95% CI 0.54 to 0.93; p=0.012) and all-cause mortality (HR 0.57; 95% CI 0.41 to 0.80; p=0.001). These findings support the safety and potential benefit of initiating SGLT2 inhibitors during hospitalization for HF, even if individual trial results are modest.

Sources:

(2025, August 30). European Society of Cardiology. Evidence appears supportive for the initiation of SGLT2 inhibitors in patients hospitalised for heart failure. [Press release]. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Evidence-appears-supportive-for-the-initiation-of-SGLT2-inhibitors-in-patients-hospitalised-for-heart-failure

Berg DD, et al; DAPA ACT HF-TIMI 68 Trial Committees and Investigators. (2025, August 29). Circulation. Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure. https://pubmed.ncbi.nlm.nih.gov/40884036/