AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Early SGLT2 Inhibitor Initiation After Hospitalization for Heart Failure Reduces Readmission and Mortality: A Propensity-Matched Analysis
By Isaac R, Beshara M, Mehta D et al.
Despite guideline endorsement of SGLT2 inhibitors (SGLT2i) as foundational therapy in heart failure (HF), real-world initiation at discharge remains suboptimal. The impact of early post-discharge SGLT2i initiation on readmission and mortality across a broad, unselected HF population has not been well defined in large-scale observational datasets. We used the TriNetX Global Collaborative Network (191.6 million patients, 179 healthcare organizations) to identify adults hospitalized with HF (ICD-10 I50.x) who were initiated on an SGLT2i (dapagliflozin, empagliflozin, canagliflozin, or ertugliflozin) within 7 days of discharge versus those who were not. Exclusion criteria included type 1 diabetes, prior SGLT2i use, end-stage renal disease, and dialysis dependence. Propensity score matching (1:1) was performed using demographics, comorbidities (hypertension, CKD, ischemic heart disease, metabolic disorders), and prior HF hospitalization, yielding 25,811 patients per group with excellent balance (SMD <0.01). Outcomes included 30-day, 90-day, and 1-year all-cause readmission and mortality, as well as 1-year major adverse cardiovascular events (MACE: MI, stroke, cardiovascular death). Cox proportional hazards models were used, with average hazard ratios reported when proportionality assumptions were violated. Early SGLT2i initiation was associated with significantly lower 30-day readmission (4.0% vs. 31.7%; RR 0.13; HR 0.11) and mortality (3.8% vs. 6.7%; RR 0.57; HR 0.61). These benefits persisted at 90 days, with reduced readmission (4.8% vs. 37.8%; HR 0.11) and mortality (5.9% vs. 10.7%; RR 0.55). At 1 year, SGLT2i use remained associated with lower readmission (9.1% vs. 51.1%; HR 0.14) and mortality (8.5% vs. 16.4%; RR 0.52; HR 0.59). One-year MACE was modestly but significantly reduced (16.2% vs. 17.0%; RR 0.95; p=0.013). In this large, propensity-matched cohort of 51,622 HF patients, initiation of SGLT2i within 7 days of discharge was associated with substantial and sustained reductions in readmission and all-cause mortality, along with modest reductions in MACE. These findings highlight the early post-discharge period as a critical window for optimizing HF therapy and support efforts to improve inpatient SGLT2i initiation.