{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:56:34Z","timestamp":1790697394949,"version":"4.1.0"},"reference-count":34,"publisher":"IMR Press","issue":"9","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Sodium-glucose cotransporter 2 (SGLT2) inhibitors have fundamentally reshaped the pharmacological management of chronic heart failure (HF). However, the role of these inhibitors during the vulnerable phase of acute decompensated heart failure (ADHF) has historically been limited by concerns regarding hemodynamic stability and renal function. Recent clinical evidence suggests that the intensive care unit (ICU) and coronary care unit (CCU) may be optimal settings for initiating these disease-modifying therapies. This narrative review aims to evaluate the safety, efficacy, and clinical impact of early in-hospital initiation of SGLT2 inhibitors in patients admitted for ADHF, focusing on hemodynamic recovery, decongestion, and prevention of early readmission. Early initiation of SGLT2 inhibitors is associated with significant clinical benefits, including rapid decongestion, shorter length of hospital stay, and a reduction in the 30-day composite endpoint of death or worsening HF. Furthermore, SGLT2 inhibitors exhibit synergistic effects with loop diuretics, helping to overcome diuretic resistance. Safety profiles remain favorable when patients satisfy basic clinical stability criteria. The traditional wait-and-see approach to initiating SGLT2 inhibitors is being replaced by a proactive early-start strategy. In the cardiac intensive care setting, SGLT2 inhibitors are no longer viewed solely as metabolic agents but also as tools for acute hemodynamic optimization. Further research is required to refine the management of euglycemic ketoacidosis and to determine the optimal timing of initiation in patients requiring mechanical circulatory support.<\/jats:p>","DOI":"10.31083\/rcm53604","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:57:11Z","timestamp":1790693831000},"source":"Crossref","is-referenced-by-count":0,"title":["Early Initiation of Sodium-Glucose Cotransporter 2 Inhibitors in Acute Decompensated Heart Failure: Efficacy, Safety, and Implementation in Stabilized Patients"],"prefix":"10.31083","volume":"27","author":[{"given":"Alfredo","family":"Mauriello","sequence":"first","affiliation":[{"name":"S.C. Cardiology, Institute National Cancer, IRCCS, Fondazione \u201cG. Pascale\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Correra","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedali Riuniti University Hospital, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Chiara","family":"Maratea","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, ASL Napoli 1 Centro, 80145 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Cetoretta","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital \u201cOspedali Riuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4119-9397","authenticated-orcid":true,"given":"Francesco","family":"Giallauria","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, \u201cFederico II\u201d University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-7127","authenticated-orcid":true,"given":"Giovanni","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, \u201cFederico II\u201d University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Desiderio","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Department of Cardiology, \u201cUmberto I\u201d Hospital, 84014 Nocera Inferiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sabatella","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Department of Cardiology, \u201cUmberto I\u201d Hospital, 84014 Nocera Inferiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Gioia","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Department of Cardiology, \u201cUmberto I\u201d Hospital, 84014 Nocera Inferiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Marrazzo","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Department of Cardiology, \u201cUmberto I\u201d Hospital, 84014 Nocera Inferiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biagio","family":"Liccardo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Translational Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, \u201cV. Monaldi\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9227-0360","authenticated-orcid":true,"given":"Vincenzo","family":"Russo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Translational Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, \u201cV. Monaldi\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Trambaiolo","sequence":"additional","affiliation":[{"name":"Intensive Cardiac Care Unit, Department of Cardiology, Sandro Pertini Hospital, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonello","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Department of Cardiology, \u201cUmberto I\u201d Hospital, 84014 Nocera Inferiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. 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