With sodium-glucose co-transporter 2 (SGLT-2) inhibitors becoming increasingly relevant for the treatment and prevention of heart failure (HF), study investigators sought to assess various SGLT-2 inhibitors in patients with established HF at baseline, focusing on different types of HF. Data were pooled using a random-effects model, and the study team conducted randomized controlled trials of SGLT-2 inhibitors versus comparators in patients with HF reporting clinical outcomes. The primary efficacy outcome was the composite of hospitalization for HF (HFF) or cardiovascular (CV) mortality.

All-cause mortality, CV mortality, and HHF were considered as secondary endpoints. Subgroup analyses involving status of diabetes, type of HF, administered type of SGLT-2 inhibitor, sex, age, BMI, eGFR, cause of HF, and concomitant medication were performed. For the main analyses for all endpoints, the study team found: HHF + CV mortality (relative risk reduction [RRR], 27%; risk ratio [RR], 0.73; 95% CI, 0.68-078); HHF (RRR, 32%; RR 0.68; 95% CI, 0.68-0.78); CV mortality (RRR, 18%; RR, 0.82; 95% CI, 0.73-0.91); and all-cause mortality (RRR, 17%; RR, 0.83; 95% CI, 0.75-0.91). For status of diabetes mellitus, they found: diabetes (RRR, 28%; RR, 0.72; 95% CI, 0.67-0.78) and non-diabetes (RRR, 24%; RR, 0.72; 95% CI, 0.66-0.87). For type of HF, they found: HFrEF (EF ≤40%, EF ≤45%) (RRR, 26%; RR, 0.74; 95% CI, 0.68-0.81); HFmEF (EF 40%-50%) (RRR, 42%; RR 0.58; 95% CI, 0.40-0.83); HFpEF (EF>45%, EF>50%) (RRR, 27%; RR, 0.73; 95% CI, 0.52-0.86); and acute HF (RRR, 33%; RR, 0.67; 95% CI, 0.52-0.86). Based on these findings, SGLT-2 inhibitors are associated with improved outcome in patient with HF, the study authors concluded.