EFFICACY AND SAFETY OF SGLT2 INHIBITORS IN HEART FAILURE WITH PRESERVED OR MILDLY REDUCED EJECTION FRACTION: A SYSTEMATIC REVIEW

Abstract

 Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent clinical syndrome associated with reduced quality of life, recurrent hospitalizations, and increased cardiovascular morbidity and mortality. In this context, sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as an important therapeutic strategy. The objective of this systematic review was to analyze the available evidence on the efficacy and safety of SGLT2 inhibitors in patients with heart failure with preserved or mildly reduced ejection fraction, with emphasis on major cardiovascular outcomes, heart failure hospitalization, quality of life, and adverse events. A systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020), using the PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, SciELO, and Virtual Health Library (VHL) databases. Original clinical studies involving adult patients with heart failure and preserved or mildly reduced ejection fraction, in which efficacy and/or safety outcomes related to SGLT2 inhibitors were evaluated, were included. After the selection process, 25 publications were included, originating from different analyses of the main clinical studies available. The results demonstrated a consistent reduction in events related to worsening heart failure, particularly hospitalizations, in addition to benefits in symptoms, health status, quality of life, and cardiorenal outcomes. These effects were observed across different clinical profiles, regardless of the presence of diabetes mellitus, and the overall safety profile was favorable. It is concluded that SGLT2 inhibitors have a favorable efficacy and safety profile in HFpEF or mildly reduced ejection fraction, representing an important pharmacological strategy for reducing the burden of heart failure-related events and improving patients’ clinical status.