Dapagliflozin has been shown to reduce the cardiovascular death and worsening HF in patients with reduced ejection fraction and is likely to be incorporated as a part of guideline-directed medical therapy in patients with established chronic heart failure, either with or without diabetes. Based on both the promising pharmacological and safety profile of dapagliflozin we hypothesized that it might exerts positive effects during hospitalization with acute HF when compared to structured usual care. Clinical evidence from randomized trials in AHF hospitalized patient are so far lacking. The aim of present study is to investigate the efficacy and safety of early initiation of dapagliflozin in those patients.
Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT2i), increases natriuresis alone and synergistically when combined with loop diuretics in patients with AHF without increasing renin angiotensin- aldosterone activity. Thus, adding SGLT2i to the standard loop diuretic therapy might confer additional decongestive and natriuretic benefits while avoiding the adverse electrolyte abnormalities and neurohormonal activation associated with other diuretic combination. These potential benefits may help with improved clinical outcomes, but clinical evidence is still lacking.