SGLT2 INHIBITORS IN HFPEF AND HFMREF: A COMPREHENSIVE PRISMA SYSTEMATIC REVIEW

Abstract

Background: Heart failure with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF) represents over half of HF cases. Historically lacking effective treatments, recent evidence shows strong benefits of sodium–glucose cotransporter-2 (SGLT2) inhibitors.
Objective: To systematically review randomized trials, meta-analyses, guidelines, and observational evidence evaluating SGLT2 inhibitors in HFpEF/HFmrEF.
Methods: PRISMA-guided search of PubMed, Cochrane, and cardiology journals up to Nov 2025.
Results: SGLT2 inhibitors consistently reduced HF hospitalizations (~20–25%), improved KCCQ quality-of-life scores, and significantly lowered composite CV death/HF hospitalization. Mortality reduction remains modest. Safety signals were minimal.
Conclusion: SGLT2 inhibitors represent the most impactful advance in HFpEF/HFmrEF treatment, warranting Class I guideline recommendations