{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:32:16Z","timestamp":1792467136353,"version":"4.5.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2025,11,18]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>SGLT2 (sodium-glucose cotransporter-2) inhibitors reduce the risk of cardiovascular death or worsening heart failure (HF) in outpatients with HF. Data on initiation in patients hospitalized for HF are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We conducted a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of in-hospital initiation of dapagliflozin (10 mg daily) in patients hospitalized for HF. The primary efficacy outcome was a composite of time to cardiovascular death or worsening HF through 2 months. Key safety outcomes included symptomatic hypotension and worsening kidney function. A prespecified meta-analysis of randomized trials evaluating initiation of SGLT2 inhibitors in patients hospitalized for HF was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 2401 patients (median age, 69 [Q1\u2013Q3, 58\u201377] years, 815 [33.9%] women, 448 [18.7%] Black race, 1717 [71.5%] left ventricular ejection fraction \u226440%, 1074 [44.7%] newly diagnosed HF) randomized between September 2020 and March 2025, 1218 were assigned to dapagliflozin and 1183 to placebo. The primary outcome occurred in 133 patients (10.9%) in the dapagliflozin group and 150 (12.7%) in the placebo group (hazard ratio [HR], 0.86 [95% CI, 0.68\u20131.08];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.20). A worsening HF event occurred in 115 (9.4%) and 122 (10.3%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.91 [95% CI, 0.71\u20131.18]). Cardiovascular death occurred in 30 (2.5%) and 37 (3.1%) patients (HR, 0.78 [95% CI, 0.48\u20131.27]), and death from any cause occurred in 36 (3.0%) and 53 (4.5%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.66 [95% CI, 0.43\u20131.00]). The rates of symptomatic hypotension were 3.6% and 2.2%, and the rates of worsening kidney function were 5.9% and 4.7% with dapagliflozin and placebo, respectively. In a meta-analysis of patients hospitalized for HF, SGLT2 inhibitors reduced the early risk of cardiovascular death or worsening HF (HR, 0.71 [95% CI, 0.54\u20130.93]\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.012) and of all-cause death (HR, 0.57 [95% CI, 0.41\u20130.80];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In this trial, in-hospital initiation of dapagliflozin did not significantly reduce the risk of cardiovascular death or worsening HF through 2 months in hospitalized HF patients. However, the totality of randomized clinical trial data suggests that in-hospital initiation of SGLT2 inhibitors may reduce the early risk of cardiovascular death or worsening HF and of all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04363697.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.076575","type":"journal-article","created":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T06:15:08Z","timestamp":1756534508000},"page":"1411-1422","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":57,"title":["Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure"],"prefix":"10.1161","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0366-5492","authenticated-orcid":true,"given":"David D.","family":"Berg","sequence":"first","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4637-4361","authenticated-orcid":true,"given":"Siddharth M.","family":"Patel","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7714-4446","authenticated-orcid":true,"given":"Paul M.","family":"Haller","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."},{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (P.M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby L.","family":"Cange","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2128-6752","authenticated-orcid":true,"given":"Michael G.","family":"Palazzolo","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4988-4532","authenticated-orcid":true,"given":"Andrea","family":"Bellavia","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia F.","family":"Kuder","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1443-0701","authenticated-orcid":true,"given":"Akshay S.","family":"Desai","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1254-6636","authenticated-orcid":true,"given":"Silvio E.","family":"Inzucchi","sequence":"additional","affiliation":[{"name":"Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":true,"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9999-111X","authenticated-orcid":true,"given":"Eileen","family":"O\u2019Meara","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universit\u00e9 de Montr\u00e9al, Montreal, Canada (E.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-8533","authenticated-orcid":true,"given":"Subodh","family":"Verma","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada (S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9455-9224","authenticated-orcid":true,"given":"Jan","family":"B\u011blohl\u00e1vek","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, Cardiovascular Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic (J.B.)."},{"name":"Institute for Heart Diseases, Wroclaw Medical University, Wroc\u0142aw, Poland (J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0732-2104","authenticated-orcid":true,"given":"Jaros\u0142aw","family":"Dro\u017cd\u017c","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Lodz, Lodz, Poland (J.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6514-0723","authenticated-orcid":true,"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9545-3675","authenticated-orcid":true,"given":"Modele O.","family":"Ogunniyi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.O.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1\u0161","family":"Drasnar","sequence":"additional","affiliation":[{"name":"Slan\u00fd Municipal Hospital, Slan\u00fd, Czech Republic (T.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3570-8370","authenticated-orcid":true,"given":"Joseph L.","family":"Izzo","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine, University at Buffalo, Erie County Medical Center, Buffalo, NY (J.L.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balazs","family":"Sarman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uzsoki Hospital, Budapest, Hungary (B.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John 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Jadwigi Kr\u00f3lowej w Rzeszowie; Kolegium Nauk Medycznych Uniwersytet Rzeszowski, Rzesz\u00f3w, Poland (A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4712-3206","authenticated-orcid":true,"given":"Christian T.","family":"Ruff","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s Hospital, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., C.T.R., M.L.O., S.A.M., M.S.S.)."},{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (D.D.B., S.M.P., P.M.H., A.L.C., M.G.P., A.B., J.F.K., A.S.D., C.T.R., M.L.O., S.A.M., M.S.S., S.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8663-0067","authenticated-orcid":true,"given":"Michelle L.","family":"O\u2019Donoghue","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Brigham and Women\u2019s 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