# Impact of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) on Cardiovascular Outcomes in Heart Failure With Reduced Ejection Fraction Under Contemporary Standard Care: A Systematic Review and Meta-Analysis

## TL;DR

This study finds that SGLT2 inhibitors reduce heart failure hospitalizations and cardiovascular deaths in patients with reduced ejection fraction, regardless of diabetes status.

## Contribution

The study provides updated evidence on SGLT2i efficacy in HFrEF under modern standard care, including both diabetic and non-diabetic subgroups.

## Key findings

- SGLT2i reduced cardiovascular mortality by 23% compared to standard care.
- Hospitalization for heart failure was reduced by 25% with SGLT2i treatment.
- No significant reduction in all-cause mortality was observed.

## Abstract

This systematic literature review and meta-analysis evaluates the efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing key cardiovascular outcomes, namely hospitalization for heart failure, cardiovascular mortality, and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). A total of 12 publications (including subgroup analyses) were analyzed. The selected RCTs compared the effects of SGLT2i (empagliflozin, dapagliflozin, and canagliflozin) with standard care among patients with HFrEF. The pooled data demonstrated that SGLT2i significantly reduced the risk of cardiovascular mortality by 23% and hospitalization for heart failure by 25%, compared to standard care. These benefits were consistently observed across both diabetic and non-diabetic subgroups, underscoring the broader therapeutic potential of SGLT2i in HFrEF management. However, no statistically significant reduction in all-cause mortality was identified. While the findings affirm the cardioprotective effects of SGLT2i, the lack of impact on overall mortality highlights the need for further longitudinal studies. These results support the integration of SGLT2i into contemporary HFrEF treatment protocols while informing future research priorities.