# Do SGLT2 inhibitors reduce mortality in heart failure with reduced ejection fraction?

Canonical page: https://cliniatlas.com/evidence/sglt2-inhibitors-heart-failure-reduced-ejection-fraction/

**Summary:** Yes — a class effect reducing cardiovascular death and heart-failure hospitalisation, independent of diabetes status.

In heart failure with reduced ejection fraction (HFrEF), SGLT2 inhibitors reduce both mortality and hospitalisation. DAPA-HF randomised 4,744 patients with LVEF <=40% to dapagliflozin or placebo and found a significant reduction in the composite of worsening heart failure or cardiovascular death, with a reduction in all-cause mortality [1].

EMPEROR-Reduced randomised 3,730 patients with LVEF <=40% to empagliflozin or placebo and reported a consistent reduction in the composite of cardiovascular death or heart-failure hospitalisation, driven substantially by fewer hospitalisations [2].

A prespecified meta-analysis of both trials (over 8,000 patients) confirmed reductions in all-cause death, cardiovascular death, and the composite renal endpoint, supporting a class effect. Benefit was consistent whether or not patients had type 2 diabetes [3], which is why these agents are now recommended as a pillar of HFrEF therapy rather than as glucose-lowering drugs alone.

## Limitations

- Trials enrolled patients already receiving guideline-directed medical therapy, so results reflect added benefit on top of existing treatment, not monotherapy.
- Patients with advanced kidney impairment below the trial eGFR thresholds were excluded, so benefit and safety in that group are less certain.

## Sources

1. [IV / Randomised trial] Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. New England Journal of Medicine (2019). PMID 31535829. https://pubmed.ncbi.nlm.nih.gov/31535829/
2. [IV / Randomised trial] Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. New England Journal of Medicine (2020). PMID 32865377. https://pubmed.ncbi.nlm.nih.gov/32865377/
3. [III / Systematic review] SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. The Lancet (2020). PMID 32877652. https://pubmed.ncbi.nlm.nih.gov/32877652/

Ask this question against live sources (free, no sign-in): https://cliniatlas.com/?q=Do%20SGLT2%20inhibitors%20reduce%20mortality%20in%20heart%20failure%20with%20reduced%20ejection%20fraction%3F

---

CliniAtlas is an EU-hosted clinical evidence search platform for verified
healthcare professionals, built in Split, Croatia, with the University of
Split School of Medicine. Free for verified clinicians and students:
https://cliniatlas.com/

For literature search, education, and professional evidence review only.
Not for diagnosis, treatment selection, triage, monitoring, prognosis, or
patient-specific clinical decision-making.