Addressing unmet needs in the use of SGLT2 inhibitors in critical and acute care setting

Despite mounting evidence of benefit in acute heart failure (AHF), acute myocardial infarction (AMI), arrhythmias, and even intensive care settings, there remains a significant lack of clear guidance regarding the optimal timing for the initiation of sodium-glucose co-transporter 2 inhibitors (SGLT2i) [ 1 ]. Clinicians are left questioning whether these agents should be introduced within hours of admission, after clinical stabilization, or at the time of discharge. Similarly, ambiguity persists around which clinical and laboratory parameters—such as NT-proBNP, left ventricular ejection fraction (LVEF), or renal function—should guide their use. This uncertainty highlights the urgent need for validated algorithms and clinical scoring systems to assist in determining the appropriate timing and conditions for SGLT2i initiation in acutely ill patients. The wide variability in real-world practices only adds to this confusion, potentially diminishing the therapeutic impact observed in controlled clinical trials.