Efficacy of SGLT2 Inhibitors in Patients with Heart Failure: An Overview of Systematic Reviews


West Florida


Citrus Memorial Hospital

Document Type


Publication Date



Evidence appraisal, Heart failure related hospitalization, KCCQ score, Kidney outcomes


Cardiovascular Diseases | Internal Medicine


AIMS: Sodium-Glucose transporter 2 inhibitors (SGLT2i) have been shown to have benefit in patients with heart failure (HF). Multiple systematic reviews and meta-analyses (SR and MA) of randomized control trials (RCTs) comparing SGLT2i to placebo have been performed. However, there is uncertainty in the quality of the evidence and associated efficacy. We performed an overview of SR and MA of RCTs to summarize the evidence related to the efficacy of SGLT2i for the management of HF.

METHODS AND RESULTS: A comprehensive search of three databases (the Cochrane Library, EMBASE, and PubMed) was conducted until February 21, 2021. All SRs and MA of RCTs evaluating the efficacy of SGLT2i in patients with HF were eligible for inclusion. The primary outcome was all-cause mortality. Methodological quality was evaluated using the AMSTAR-2 assessment tool. The overall quality of evidence was summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. The initial search yielded 3431 references, of which, eight SRs and MA met the inclusion criteria. The methodological quality ranged from critically low to high. The overall quality of evidence ranged from very low to moderate. Most of the SRs and MA showed benefits in all-cause mortality, HF-related hospitalizations, and change in Kansas City Questionnaire Score.

CONCLUSIONS: SGLT2i are possibly beneficial in patients with HF, however, none of the SRs and MA compared the efficacy between different types of SGLT2i. Furthermore, this paper emphasizes the need for consistent reproducible conduct and reporting of SRs to generate high-quality evidence and facilitate clinical decision-making.

Publisher or Conference

International Journal of Cardiology