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Early SGLT2 inhibition in acute heart failure: when more urine does not necessarily mean better decongestion
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DOI：10.1093/ejhf/xuag221.png)
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Abstract
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Zonneveld and colleagues report an individual patient-level meta-analysis of early initiation of sodium-glucose co-transporter 2 (SGLT2) inhibitor therapy in acute heart failure. Across six randomized trials comprising 623 patients, early SGLT2 inhibition increased 24-h diuresis but showed no clear natriuretic signal. In patients with available post-discharge outcome data, SGLT2 inhibition was associated with a lower 60-day composite risk of all-cause mortality or heart failure rehospitalization, and the win-ratio analysis favoured SGLT2 inhibition. The clinical signal is reassuring. Mechanistic interpretation is less secure because greater urine output without a parallel natriuretic signal should not be treated as proof of sodium-directed decongestion.1
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