Research Progress of SGLT2 Inhibitors in the Treatment of Acute Heart Failure: A Narrative Review
Abstract
Acute heart failure (AHF) is the main cause of hospitalization in patients with heart failure (HF). Although traditional therapies play an important role in symptom relief, their efficacy in reducing mortality, rehospitalization rates, and improving long-term prognosis remains unsatisfactory. In recent years, sodium‑glucose cotransporter 2 (SGLT2) inhibitors, originally developed as glucose‑lowering agents, have demonstrated significant benefits in chronic heart failure, and their potential utility in AHF is attracting increasing attention. Current evidence indicates that early initiation of SGLT2 inhibitors in patients with AHF is generally safe, improving diuretic efficiency, relieving congestion, and reducing the risk of heart failure events. However, findings on short‑term readmission rates remain inconsistent across studies. Furthermore, unresolved issues persist regarding the optimal timing of initiation and safety in specific patient populations. This narrative review summarizes the available evidence up to 31 March 2026, with emphasis on key clinical trials, including DAPA ACT HF-TIMI 68, and selected real-world studies. We discuss the potential benefits, safety considerations, unresolved controversies, and evidence gaps regarding the use of SGLT2 inhibitors in AHF, aiming to provide a clinically oriented reference for future research and practice.
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