Evidence regarding initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) during hospitalization for acute heart failure (AHF) remains limited. A retrospective cohort analysis presented at the Heart Failure 2026 evaluated the association between in-hospital SGLT2 inhibitor use and all-cause in-hospital mortality among patients admitted with AHF. 

The study included adults admitted to the cardiac intensive care unit for AHF, with or without acute coronary syndromes, between July 2023 and April 2025. Patients were categorized according to in-hospital SGLT2 inhibitor use. Individuals with dialysis dependence, prior cardiac or renal transplantation, estimated glomerular filtration rate below 30 mL/min/1.73 m², cardiogenic shock, diabetic ketoacidosis, symptomatic hypotension, or early transfer were excluded.

Findings

• A total of 1,546 patients with acute heart failure were included. Mean age was 63.4 ± 15.1 years, 57.5% were male, mean left ventricular ejection fraction was 44.4 ± 14.6%, and mean estimated glomerular filtration rate was 62.6 ± 40.1 mL/min/1.73 m².
• SGLT2 inhibitors were initiated in 18.6% of patients, and overall in-hospital mortality was 10.7%.
• In-hospital mortality was lower among SGLT2i users compared with non-users (7.3% vs 13.4%; p=0.003).
• Lower mortality associated with SGLT2i use was observed in patients with mild renal impairment (p<0.001), moderate renal impairment (p<0.001), preserved ejection fraction (p<0.001), moderately reduced ejection fraction (p<0.001), dyslipidemia (p=0.022), hypertension (p=0.007), and atrial fibrillation (p=0.006).
• No significant mortality reduction was observed in patients with severe renal dysfunction, hypotension, or major potassium abnormalities.

The analysis showed that in-hospital SGLT2 inhibitor use in acute heart failure was associated with lower all-cause in-hospital mortality in this retrospective cohort. Prospective studies are needed to confirm these findings.