Real-world use of SGLT2 inhibitors significantly reduced heart failure hospitalization rates (pooled HR 0.65; 95% CI 0.59-0.72) and all-cause mortality (OR 0.60; 95% CI 0.50-0.70).
Meta-Analysis (n=4,800,000)
Yes
Do SGLT2 inhibitors reduce heart failure hospitalisation and mortality in real-world heart failure patients?
Real-world evidence confirms that SGLT2 inhibitors significantly reduce heart failure hospitalizations and mortality across diverse HF phenotypes, mirroring RCT results.
Effect estimate: HR 0.65 (95% CI 0.59-0.72)
Background Sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors have demonstrated significant benefits in heart failure (HF) patients in randomised controlled trials (RCTs). However, real‐world evidence (RWE) is crucial to confirm their efficacy in broader, unselected patient populations. This meta‐analysis is aimed at synthesising real‐world data on SGLT2 inhibitors in HF across various ejection fraction phenotypes. Methods We conducted a systematic review and meta‐analysis of real‐world observational studies on SGLT2 inhibitor use in HF patients. Comprehensive searches were performed across PubMed/MEDLINE, Embase, Web of Science, and Scopus. Data were pooled using random‐effects models, assessing heterogeneity and bias and performing subgroup analyses. The review followed PRISMA guidelines and was PROSPERO‐registered (CRD420261356715). Results Our search yielded over 4000 unique articles, with 21 observational studies (encompassing nearly 4.8 million HF patients from 17 countries) included in the quantitative meta‐analysis. SGLT2 inhibitors consistently reduced HF hospitalisation rates in real‐world use (pooled HR 0.65, 95% CI 0.59–0.72). This included a significant reduction in those with cardiovascular disease (HR 0.78, 95% CI 0.68–0.89) and without cardiovascular disease (HR 0.53, 95% CI 0.39–0.71). The absolute risk reduction for hospitalisation for HF in people with a history of CVD (ARR 1.17, 95% CI 0.78–1.55) was significantly greater than for those without CVD (ARR 0.39, 95% CI 0.32–0.47). The number‐needed‐to‐treat to prevent one hospitalisation for HF was 86 (95% CI 65–128) over 1 year of treatment for the CVD group and 256 (95% CI 215–316) over 1 year of treatment for those without CVD. SGLT2 inhibitors also significantly reduced all‐cause mortality (pooled OR 0.60, 95% CI 0.50–0.70) and cardiovascular mortality (OR 0.65, 95% CI 0.55–0.75). No new safety signals emerged, with SGLT2 inhibitors generally well tolerated. Conclusion Real‐world SGLT2 inhibitor use significantly reduces hospitalisations and mortality across diverse HF phenotypes, mirroring trial results. Broad implementation could substantially improve population‐level outcomes.
E et al. (2026) conducted a meta-analysis in Heart failure (n=4,800,000). SGLT2 inhibitors was evaluated on Heart failure hospitalisation rates (HR 0.65, 95% CI 0.59-0.72). Real-world use of SGLT2 inhibitors significantly reduced heart failure hospitalization rates (pooled HR 0.65; 95% CI 0.59-0.72) and all-cause mortality (OR 0.60; 95% CI 0.50-0.70).