EVALUATION OF THE EFFICACY OF SGLT2 INHIBITOR THERAPY IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract

Objectives. This literature review aims to evaluate the clinical and pathophysiological efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with heart failure with preserved ejection fraction (HFpEF), given the historical lack of therapies with proven prognostic benefit for this subgroup.

Methods. A comprehensive analysis of literature sources was conducted using databases such as PubMed, Google Scholar, and HINARI. The review included major randomized clinical trials (EMPEROR-Preserved, DELIVER, PRESERVED-HF, SOLOIST-WHF, EMPULSE), relevant meta-analyses, pathophysiological mechanisms, and current recommendations from international guidelines (ACC/AHA/HFSA and ESC), regarding heart failure with preserved ejection fraction (HFpEF). The search was performed using the following keywords: ”SGLT2 inhibitors”, ”heart failure with preserved ejection fraction”, ”empagliflozin”, ”dapagliflozin”.

Results. The EMPEROR-Preserved and DELIVER studies demonstrated that empagliflozin and dapagliflozin significantly reduce (by approximately 20%) the risk of hospitalization for heart failure in HFpEF patients, with consistent effects regardless of diabetic status and across the ejection fraction spectrum above 40%. The PRESERVED-HF trial confirmed improvements in quality of life and functional capacity with dapagliflozin. Meta-analyses reinforced these findings, showing consistent reductions in clinical events and additional renal benefits. The safety profile proved favorable, with minimal and manageable adverse effects (minor genitourinary infections, transient hypotension).

Conclusions. SGLT2 inhibitors represent the first class of medications with robust evidence of efficacy in the treatment of HFpEF, reducing recurrent hospitalizations and improving patients’ symptoms and functionality. This therapeutic class has been rapidly adopted into international guidelines, fundamentally changing the clinical approach to HFpEF patients. Broad implementation of SGLT2 inhibitors is recommended for all eligible patients, reflecting a major paradigm shift in the management of heart failure with preserved ejection fraction.