Early SGLT2i therapy facilitates in-hospital ARNI introduction improving 6-month systolic function in patients with HFrEF

Purpose Heart failure with reduced ejection fraction (HFrEF) represents a complex clinical syndrome requiring the timely initiation of disease-modifying therapies. However, the optimal timing for introducing these therapies in the hospital setting remains an area of investigation. This study aims to evaluate whether the early in-hospital initiation of sodium–glucose co-transporter 2 inhibitors (SGLT2i) facilitates the introduction of angiotensin receptor–neprilysin inhibitors (ARNI) during hospitalization and whether this strategy is associated with improved left ventricular systolic function at 6-month follow-up. Methods In this prospective, observational, single-centre study, consecutive patients with HFrEF were enrolled and divided into two groups on the basis of the timing of SGLT2i initiation: Group 1 (in-hospital) and Group 2 (post-discharge). The differences in terms of ARNI introduction within hospitalization were evaluated in the two groups. Changes in echocardiographic parameters (left ventricular ejection fraction [LVEF], left ventricular end-diastolic volume [LVEDV], left ventricular end-systolic volume [LVESV], E/e′ ratio) at 6-month follow up have been compared among patients treated with ARNI+SGLT2i and SGLT2i alone. Results A total of 285 patients were enrolled, 151 for G1 and 134 for G2. Early in-hospital use of SGLT2i was an independent predictor of ARNI initiation before discharge (odds ratio, OR: 3.31; 95% confidence intervals, CI 1.87–5.84; p < 0.001). Among the 89 patients of G1 who completed 6 months of follow-up, early in-hospital therapy with SGLT2i and ARNI represents an independent significant predictor of LVEF > 10% improvement, compared with those treated with SGLT2i alone (OR: 5.353; 95% CI 1.504–12.070; p < 0.003). Conclusions Early in-hospital initiation of SGLT2i in patients with HFrEF is associated with a higher likelihood of in-hospital ARNI introduction and with significant improvements in left ventricular systolic function at 6-month follow-up.