Changes in NT-proBNP Levels According to SGLT2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure Decompensation: A Prospective Cohort Study

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have proven beneficial in chronic heart failure (HF) across a wide range of left ventricular ejection fractions (LVEFs). Emerging data suggests that these benefits may extend to acute HF decompensation through enhanced decongestion. Purpose: To investigate changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels according to SGLT2i use among patients hospitalized for acute HF decompensation. Methods: In this prospective cohort study, consecutive patients hospitalized for HF decompensation were enrolled. Demographics, comorbidities, and cardiovascular risk factors were recorded. Participants were classified into three groups: Group 1—No SGLT2i use or discontinuation; Group 2—Prior SGLT2i use and continuation; Group 3—SGLT2i-naïve with initiation during hospitalization. NT-proBNP was measured on admission and discharge. Results: A total of 159 patients (median age 79 years, 64.8% male) were included. Group 1 patients exhibited negligible changes in NT-proBNP, whereas those continuing or newly initiating SGLT2i demonstrated significant reductions (absolute change: 506 8792 pg/mL vs. −5610 9461 pg/mL vs. −3602 4409 pg/mL, p = 0.001, percentage change: −2.1 63.4% vs. −30.3 39.0% vs. −38.3 41.5%, p = 0.001). Multivariable regression confirmed that SGLT2i continuation or initiation independently predicted greater NT-proBNP reduction. Conclusions: NT-proBNP levels were significantly reduced among patients with decompensated HF treated with SGLT2i, with the greatest reduction in treatment-naïve patients. These findings highlight the potential role of SGLT2i even during acute HF hospitalization.