# SGLT2 inhibitors (drug class) Drug · id `cardio:sglt2-inhibitors` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: Sodium-glucose cotransporter 2 inhibitors Browse, organ or system: Heart Browse, condition area: Heart failure; Diabetes and metabolic disease; Kidney connections ## In plain language A group of pills that a US government patient page says were approved for diabetes because they lower blood sugar. Four trials in this atlas tested dapagliflozin or empagliflozin in adults with heart failure. In each, the drug group had a lower rate than the placebo group of cardiovascular death or worsening heart failure. The abstracts report the results in people with and without diabetes. Two of the trials enrolled people with an ejection fraction of 40% or less and two enrolled people above 40%. ## Technical summary US drug-label classes in RxClass for dapagliflozin and empagliflozin: mechanism-of-action class Sodium-Glucose Transporter 2 Inhibitors and established pharmacologic class Sodium-Glucose Cotransporter 2 Inhibitor. The MeSH heading D000077203 is an exact match. This is the shared class page: the diabetes and kidney trials of the same medicines sit in other areas of the atlas. Class-level results are a side-by-side list of four trial results and not a pooled analysis. ## Claims, with the population each applies to ## Context: Symptomatic patients with chronic HFrEF (2022 AHA/ACC/HFSA, as summarized by the ACC) Recipient: Recipient not specified; Population: Symptomatic patients with chronic heart failure with reduced ejection fraction (ejection fraction of 40% or less), with or without type 2 diabetes, as the ACC summary words the SGLT2 inhibitor statement. The summary gives no age limits.; Care setting: Not stated in the ACC summary.; Geography: Not stated in the ACC summary (issued by American societies; jurisdiction not verified); Life stage: Not stated in the ACC summary; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (guideline context) ### An ACC summary of the 2022 heart failure guideline of the AHA, ACC and HFSA says that in symptomatic patients with chronic heart failure with reduced ejection fraction, an SGLT2 inhibitor is recommended in order to cut hospital admissions and cardiovascular death, whether or not the patient has type 2 diabetes. It prints the class of recommendation as 1a. It adds that SGLT2 inhibitors can also be beneficial in heart failure with mildly reduced or preserved ejection fraction, at class 2a. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Recipient not specified; Population: Symptomatic patients with chronic heart failure with reduced ejection fraction (ejection fraction of 40% or less), with or without type 2 diabetes, as the ACC summary words the SGLT2 inhibitor statement. The summary gives no age limits.; Care setting: Not stated in the ACC summary.; Geography: Not stated in the ACC summary (issued by American societies; jurisdiction not verified); Life stage: Not stated in the ACC summary; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (guideline context) - Limitations: The class of recommendation is as printed on the ACC page. The class 2a statement for mildly reduced and preserved ejection fraction is a different population from this claim context and is not a recommendation record here. The source is the ACC summary, not the guideline text. PubMed lists three corrections to the guideline; their text was not read, so it is not known whether they change anything stated here. - Last checked: 2026-10-15 - Source problem: a cited source is corrected. Check the sources before relying on this claim. - Sources: 1. Supports: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 145(18):e895-e1032 (issue date 2022-05-03; electronic publication 2022-04-01). PubMed abstract and bibliographic data only. PubMed lists no PMC copy. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page of the guideline (dated Apr 01, 2022), which is an ACC summary and not the guideline text. The recommendation text for this atlas comes from that page. The publisher field is the journal title as PubMed gives it.) Locator: Key perspective 3, sentence 2, fragments 1 and 2. Retrieved 2026-10-15T13:50:22Z. Source state: Corrected. Snapshot hash: 9bf3f8d91011b793cc049e80db09ae5624271eb6cdb688f5331c7f8aa1556cad. How it applies: SGLT2 inhibitor recommended in symptomatic chronic HFrEF, with or without type 2 diabetes. 2. Supports: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 145(18):e895-e1032 (issue date 2022-05-03; electronic publication 2022-04-01). PubMed abstract and bibliographic data only. PubMed lists no PMC copy. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page of the guideline (dated Apr 01, 2022), which is an ACC summary and not the guideline text. The recommendation text for this atlas comes from that page. The publisher field is the journal title as PubMed gives it.) Locator: Key perspective 3, sentence 3. Retrieved 2026-10-15T13:50:22Z. Source state: Corrected. Snapshot hash: 9bf3f8d91011b793cc049e80db09ae5624271eb6cdb688f5331c7f8aa1556cad. How it applies: Class 2a for mildly reduced and preserved ejection fraction. 3. Background: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 145(18):e895-e1032 (issue date 2022-05-03; electronic publication 2022-04-01). PubMed abstract and bibliographic data only. PubMed lists no PMC copy. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page of the guideline (dated Apr 01, 2022), which is an ACC summary and not the guideline text. The recommendation text for this atlas comes from that page. The publisher field is the journal title as PubMed gives it.) Locator: Key perspective 1, classification list (HFrEF). Retrieved 2026-10-15T13:50:22Z. Source state: Corrected. Snapshot hash: 9bf3f8d91011b793cc049e80db09ae5624271eb6cdb688f5331c7f8aa1556cad. How it applies: HFrEF means an ejection fraction of 40% or less. 4. Background: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 145(18):e895-e1032 (issue date 2022-05-03; electronic publication 2022-04-01). PubMed abstract and bibliographic data only. PubMed lists no PMC copy. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page of the guideline (dated Apr 01, 2022), which is an ACC summary and not the guideline text. The recommendation text for this atlas comes from that page. The publisher field is the journal title as PubMed gives it.) Locator: CommentsCorrectionsList, three ErratumIn entries. Retrieved 2026-10-15T13:48:58Z. Source state: Corrected. Snapshot hash: 359253a28c2add87ff845ef77e0400c1886971358eacddb04f09833df0707f1f. How it applies: Shows that corrections exist. What they change is unknown. ## Context: Adults with chronic heart failure in four placebo-controlled SGLT2 inhibitor trials, ejection fraction 40% or less in two and above 40% in two Recipient: Adult; Population: Adults with chronic heart failure in four separate trials: DAPA-HF and EMPEROR-Reduced (ejection fraction of 40% or less) and EMPEROR-Preserved and DELIVER (ejection fraction of more than 40%). Each trial added the SGLT2 inhibitor or placebo to recommended or usual therapy. The abstracts say findings were similar or consistent in people with and without diabetes. This context joins four trials for comparison and is not a pooled analysis.; Care setting: Not stated in the abstract. The registry record is not read for setting.; Geography: Multinational trials.; Life stage: Adults.; Follow-up: Median follow-up differs by trial: 18.2 months, 16 months, 26.2 months and 2.3 years (abstracts). ### In four separate placebo-controlled trials in adults with chronic heart failure, the primary outcome was lower with an SGLT2 inhibitor than with placebo. The primary outcome was a composite of cardiovascular death and worsening heart failure, defined slightly differently in each trial. The hazard ratios (95% confidence intervals) were: DAPA-HF, dapagliflozin, ejection fraction 40% or less, 0.74 (0.65 to 0.85); EMPEROR-Reduced, empagliflozin, 40% or less, 0.75 (0.65 to 0.86); EMPEROR-Preserved, empagliflozin, above 40%, 0.79 (0.69 to 0.90); DELIVER, dapagliflozin, above 40%, 0.82 (0.73 to 0.92). The abstracts report the benefit or its consistency in people with and without diabetes. In DELIVER, cardiovascular death on its own had a hazard ratio of 0.88 (0.74 to 1.05), and in EMPEROR-Preserved the effect was mainly related to fewer hospitalizations for heart failure. This lists four trial results side by side. It is not a pooled analysis. - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults with chronic heart failure in four separate trials: DAPA-HF and EMPEROR-Reduced (ejection fraction of 40% or less) and EMPEROR-Preserved and DELIVER (ejection fraction of more than 40%). Each trial added the SGLT2 inhibitor or placebo to recommended or usual therapy. The abstracts say findings were similar or consistent in people with and without diabetes. This context joins four trials for comparison and is not a pooled analysis.; Care setting: Not stated in the abstract. The registry record is not read for setting.; Geography: Multinational trials.; Life stage: Adults.; Follow-up: Median follow-up differs by trial: 18.2 months, 16 months, 26.2 months and 2.3 years (abstracts). - Limitations: The hazard ratios are the trials' own and were not pooled or re-analysed. The trials differ in entry criteria, in the drug, in the definition of the primary outcome and in follow-up. All four were funded by the drug makers. Numbers come from the PubMed abstracts; full texts were not read. Harms differ by trial and are given on the trial claims (genital and urinary tract infections and low blood pressure with empagliflozin in EMPEROR-Preserved; genital tract infection with empagliflozin in EMPEROR-Reduced). No certainty rating was assessed. - Last checked: 2026-10-14 - Sources: 1. Supports: Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-14T18:18:44Z. Source state: Current. Snapshot hash: d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c. How it applies: DAPA-HF primary outcome. Abstract of the paper from PubMed; the full text was not read. 2. Supports: Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 4. Retrieved 2026-10-14T18:18:44Z. Source state: Current. Snapshot hash: d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c. How it applies: DAPA-HF: diabetes and no diabetes. Abstract of the paper from PubMed; the full text was not read. 3. Supports: Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8. How it applies: EMPEROR-Reduced primary outcome. Abstract of the paper from PubMed; the full text was not read. 4. Supports: Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 2. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8. How it applies: EMPEROR-Reduced: consistency with and without diabetes. Abstract of the paper from PubMed; the full text was not read. 5. Supports: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970. How it applies: EMPEROR-Preserved primary outcome. Abstract of the paper from PubMed; the full text was not read. 6. Supports: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 2. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970. How it applies: EMPEROR-Preserved: the effect was mainly related to fewer hospitalizations. Abstract of the paper from PubMed; the full text was not read. 7. Supports: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 3. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970. How it applies: EMPEROR-Preserved: with or without diabetes. Abstract of the paper from PubMed; the full text was not read. 8. Supports: Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947. How it applies: DELIVER primary outcome. Abstract of the paper from PubMed; the full text was not read. 9. Supports: Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 2. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947. How it applies: DELIVER: cardiovascular death on its own. Abstract of the paper from PubMed; the full text was not read. 10. Supports: Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 4. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947. How it applies: DELIVER: ejection fraction and diabetes subgroups. Abstract of the paper from PubMed; the full text was not read. 11. Background: Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 1. Retrieved 2026-10-14T18:18:44Z. Source state: Current. Snapshot hash: d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c. How it applies: DAPA-HF: who was randomized. Abstract of the paper from PubMed; the full text was not read. 12. Background: Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 2. Retrieved 2026-10-14T18:18:44Z. Source state: Current. Snapshot hash: d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c. How it applies: DAPA-HF: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read. 13. Background: Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 1. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8. How it applies: EMPEROR-Reduced: who was randomized. Abstract of the paper from PubMed; the full text was not read. 14. Background: Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 2. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8. How it applies: EMPEROR-Reduced: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read. 15. Background: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 1. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970. How it applies: EMPEROR-Preserved: who was randomized. Abstract of the paper from PubMed; the full text was not read. 16. Background: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 2. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: 6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970. How it applies: EMPEROR-Preserved: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read. 17. Background: Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 1. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947. How it applies: DELIVER: who was randomized. Abstract of the paper from PubMed; the full text was not read. 18. Background: Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 2. Retrieved 2026-10-14T18:18:45Z. Source state: Current. Snapshot hash: dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947. How it applies: DELIVER: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read. ## Guidance, authorization and access ### Recommendation `cardio:rec-aha-acc-hfsa-2022-sglt2i-hfref` - Drug: SGLT2 inhibitors (drug class) (`cardio:sglt2-inhibitors`) - Direction: Recommended - Issued by: American College of Cardiology (`core:acc`) - Guideline record: 2022 AHA/ACC/HFSA heart failure guideline (`cardio:guideline-aha-acc-hfsa-2022-heart-failure`) - Guideline: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, edition Published in Circulation 145(18):e895-e1032 (issue date 2022-05-03; electronic publication 2022-04-01). PubMed abstract and bibliographic data only. PubMed lists no PMC copy. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page of the guideline (dated Apr 01, 2022), which is an ACC summary and not the guideline text. The recommendation text for this atlas comes from that page. The publisher field is the journal title as PubMed gives it.; snapshot `cardio:acc-hf2022-key-perspectives-2026-10-15` - Jurisdictions: Not stated; note: Issued by American societies; the source read names no jurisdiction. - Strength: Class of Recommendation 1a, as printed on the ACC summary page (ACC/AHA class of recommendation. The ACC page prints the class; the class definitions and levels of evidence were not read here.) - Effective: 2022-04-01 (The date on the ACC summary page, which matches the electronic publication date in PubMed.) - Supersession: Not checked - Applies to: Recipient: Recipient not specified; Population: Symptomatic patients with chronic heart failure with reduced ejection fraction (ejection fraction of 40% or less), with or without type 2 diabetes, as the ACC summary words the SGLT2 inhibitor statement. The summary gives no age limits.; Care setting: Not stated in the ACC summary.; Geography: Not stated in the ACC summary (issued by American societies; jurisdiction not verified); Life stage: Not stated in the ACC summary; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (guideline context) - Basis: claim `cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref` - Source problem: a cited source is corrected. Check the sources before relying on this claim. ## Connected pages - Four trials compared an SGLT2 inhibitor with placebo in adults with heart failure: Heart failure (`cardio:heart-failure`) [a claim, not a settled fact; see claim `cardio:claim-sglt2-hf-four-trials` and its context] - Files under this front: Medicines (`cardio:front-medicines`) - ACC summary of the 2022 guideline: symptomatic chronic HFrEF, with or without type 2 diabetes: Heart failure with reduced ejection fraction (HFrEF) (`cardio:hfref`) [a claim, not a settled fact; see claim `cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref` and its context] - Has subtype: Dapagliflozin (`cardio:dapagliflozin`) - Has subtype: Empagliflozin (`cardio:empagliflozin`) ## Provenance Content hash: 1807cceaa5a9e58a1aa4bc1efb3ec1c54ad8cc30f961cbab1077ee8ecc4a862d Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-14