- Question
- Does starting dapagliflozin during hospitalization for heart failure (HF) reduce cardiovascular death or worsening HF over the first 2 months?
- Design
- Multicenter, randomized, double-blind, placebo-controlled trial with 2401 patients randomized between September 2020 and March 2025. The primary outcome was assessed through 2 months. It also included a prespecified meta-analysis of SGLT2 inhibitor trials in hospitalized HF.
- Population
- Patients stabilized during a hospitalization for acute HF, with a median age of 69 years, 33.9% women, 71.5% with left ventricular ejection fraction ≤40% and 44.7% with newly diagnosed HF.
- Intervention
- Dapagliflozin 10 mg orally once daily, started in hospital and continued for 2 months (1218 patients).
- Control
- Matching placebo once daily for 2 months (1183 patients).
- Primary outcome
- Composite of time to cardiovascular death or worsening HF through 2 months.
- Results
- The primary outcome occurred in 133 patients (10.9%) with dapagliflozin and 150 (12.7%) with placebo (HR 0.86; 95% CI 0.68-1.08; P=0.20), a non-significant difference. All-cause death was 3.0% vs 4.5% (HR 0.66; 95% CI 0.43-1.00). In the meta-analysis, SGLT2 inhibitors reduced the early risk of cardiovascular death or worsening HF (HR 0.71; 95% CI 0.54-0.93).
- Safety
- Symptomatic hypotension occurred in 3.6% with dapagliflozin vs 2.2% with placebo, and worsening kidney function in 5.9% vs 4.7%.
- Conclusion
- In-hospital initiation of dapagliflozin did not significantly reduce cardiovascular death or worsening HF at 2 months, although the totality of randomized evidence suggests an early benefit of SGLT2 inhibitors.
- Why it matters
- It provided data from a large trial on early initiation of SGLT2 inhibitors during HF hospitalization and, together with the meta-analysis, supports considering starting them before discharge in stabilized patients.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026