Heart failure with preserved ejection fraction (HFpEF) represents a significant clinical challenge due to limited effective pharmacological treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, such as empagliflozin and dapagliflozin, have emerged as a novel therapeutic approach. This systematic review synthesizes evidence from 10 randomized controlled trials (RCTs) involving diverse HFpEF patient populations, including those with comorbidities like diabetes and chronic obstructive pulmonary disease.
The primary outcomes assessed were functional capacity, measured via the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and six-minute walk test (6MWT) performance, and the incidence of heart failure hospitalizations. Results consistently demonstrated that SGLT2 inhibitors significantly improved patient-reported outcomes, with KCCQ score increases ranging from 5 to 10 points, indicating clinically meaningful improvements in quality of life. Additionally, 6MWT performance improved by an average of 20-30 meters across studies, reflecting enhanced physical function.
A significant reduction in heart failure hospitalizations was observed, with relative risk reductions of up to 30% compared to placebo. These benefits were consistent across age groups, including older adults, and in patients with varying baseline ejection fractions. The safety profile of SGLT2 inhibitors was favorable, with low rates of serious adverse events, such as hypoglycemia or acute kidney injury, reported across trials. Subgroup analyses suggested that the benefits were maintained regardless of diabetes status, highlighting the broad applicability of these agents.
Limitations include variability in trial designs and the need for longer-term data to assess sustained benefits. This review underscores the role of SGLT2 inhibitors as a transformative therapy in HFpEF, offering both symptomatic relief and reduced clinical events. These findings advocate for their integration into standard HFpEF management protocols, potentially improving patient outcomes and reducing healthcare burdens.
Link: https://assets.cureus.com/uploads/review_article/pdf/405869/20250915-91633-sdi166.pdf
