Tomasoni D, Fonarow GC, Adamo M, et al. - For patients with heart failure (HF) and reduced ejection fraction (HFrEF), recommendations have been made recently in favor of using sodium-glucose co-transporter 2 (SGLT2) inhibitors as the foundational therapy because of their favorable effects on mortality, clinical events and quality of life. In clinical practice guidelines, the use of dapagliflozin and empagliflozin has been recommended regardless of diabetes history in patients with HFrEF, or sotagliflozin in those with HFrEF and concomitant type 2 diabetes mellitus (T2DM), however, uncertainty remains concerning the timing and practical integration of this class of therapies in practice. As per researchers proposal, these drugs are candidates for early, upfront administration to patients with newly diagnosed HFrEF and for patients hospitalized with HF.

• Growing evidence has established that initiation of dapagliflozin, empagliflozin or sotagliflozin initiation in diabetic patients is linked with early benefits, with clinically meaningful reductions in clinical events that reach statistical significance within days to weeks.

• Secondary analyses of major clinical trials testing these drugs in patients already receiving background HF therapy, indicated that their efficacy is independent of that.

• SGLT2 inhibitors are generally reported as safe and well tolerated.

• Findings from this review herein yield support for the early initiation of dapagliflozin and empagliflozin (or sotagliflozin limited to patients with T2DM) to rapidly improve clinical outcome and quality of life of HFrEF patients.