Heart failure & cardiomyopathiesCohort study
Short-term survival of dual SGLT2i-MRA and four-class guideline-directed medical therapy in acute heart failure
- Analysis of two prospective registries
- external validation cohort
Authors' conclusion
After AHF, early initiation of dual SGLT2i and MRA therapy was associated with lower short-term mortality, irrespective of LVEF or potassium levels. Four-class GDMT conferred the lowest risk, emphasizing the importance of timely implementation after AHF.
Study context
- Population
- Patients with acute heart failure (HF) (China HF-CAP main cohort; SwedeHF external validation cohort)HF-CAP n = 441,320
- Participants
- 71,154 / 81,793 / 36,301 / 18,374
- Exposure
- Dual SGLT2i-MRA vs neither; four-class guideline-directed medical therapy (GDMT) vs none, at discharge
- Dual SGLT2i and mineralocorticoid receptor antagonist (MRA)n = 71,154
- Neithern = 81,793reference
- Four-class GDMTn = 36,301
- No therapyn = 18,374reference
- Outcome
- CV and all-cause mortality
- Follow-up
- 90 days
Main finding
As reported in the abstract
90-day CV and all-cause death, dual therapy vs neither (main cohort)
Adjusted odds
- Dual SGLT2i and MRA vs Neither · 90-day cardiovascular (CV) death
- 0.320 (CI 0.283–0.361)
- Dual SGLT2i and MRA vs Neither · 90-day all-cause death
- 0.504 (CI 0.472–0.539)
- Four-class GDMT vs No therapy · 90-day CV death
- 0.122 (CI 0.106–0.14)
Observational data: associations, not effects.
Further findings
External validation cohort (SwedeHF)
- Results directionally consistent
Dual therapy by hyperkalaemia and HF phenotype (subgroups)
- Association consistent irrespective of hyperkalaemia and across HF phenotypes
Original publication
Short-term survival of dual SGLT2i-MRA and four-class guideline-directed medical therapy in acute heart failure. Eur J Heart Fail. Published 22 July 2026. doi:10.1093/ejhf/xuag218
Summarised from the published abstract; every number is checked against it