Isabelle Bolfe et al. Rafaela Kaucz Mendez Ribeiro Caroline Prager João Vitor Bolfe Ana Karyn Ehrenfried de Freitas
Abstract
Background:
Studies on Sodium–Glucose cotransporter-2 inhibitors (SGLT2i) in the treatment of heart failure (HF) investigate their potential as a therapeutic alternative for managing congestion and their influence on diuretic efficacy in acute decompensated HF.
Objectives:
To analyze the impact of introducing SGLT2i in patients with HF, with emphasis on the hypothesis of a potential reduction in outpatient furosemide use over time, as well as concomitant changes in renal function and clinical signs of congestion.
Methods:
Retrospective study of 85 patients with advanced HF under outpatient follow-up between January 2022 and July 2025, including those on furosemide at the time of SGLT2i prescription and excluding those without follow-up visits. Comparative analysis was performed on furosemide doses, signs of congestion, and changes in renal function across four subsequent visits.
Results:
The sample was predominantly male (56.5%), with a high prevalence of HF with reduced ejection fraction (82.4%). After the introduction of SGLT2i, results showed a reduction in jugular venous distension and lower-limb edema, accompanied by increased creatinine levels and a rise in mean furosemide dose from 59.66 ± 4.87 mg to 79.05 ± 7.28 mg (p = 0.003).
Conclusion:
Following the introduction of SGLT2i, an increase in the mean furosemide dose was observed. This finding was associated with elevated creatinine levels, despite modest improvement in clinical signs of congestion, highlighting the dynamic scenario analyzed and the need for prospective studies with follow-up across different stages of HF.
