A Landmark Presentation at ESC 2025

At the 75th European Society of Cardiology (ESC) conference in vibrant Madrid, Spain, Dr. David Berg, MD MPH, unveiled groundbreaking results from the DAPA-ACT HF-TIMI 68 trial on August 30, 2025. This study focused on the clinical potential of AstraZeneca’s dapagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i), aimed at patients battling acute heart failure (HF).

Trial Findings: Promising Yet Cautious

While the DAPA-ACT HF-TIMI 68 trial revealed that initiating dapagliflozin during hospital stays did not significantly lower rates of cardiovascular death or worsening heart failure over two months, other randomized trials suggest a silver lining. These trials indicate that early initiation of SGLT2 inhibitors might actually decrease the high risk of adverse outcomes, such as cardiovascular mortality and overall hospital readmissions, shortly after discharge. Encouragingly, dapagliflozin was deemed safe and well-tolerated by hospitalized patients, reinforcing its favorable safety profile.

Acknowledging Limitations

Dr. Berg acknowledged certain drawbacks of the study, notably its limited scale and a lower-than-expected occurrence of key events. Despite these hurdles, the DAPA-ACT HF-TIMI 68 trial stands as a pioneering large-scale effort to assess the safety and efficacy of launching dapagliflozin during hospitalization for acute heart failure.

The Rising Tide of Acute Heart Failure

Acute heart failure is increasingly common, imposing a staggering financial strain on healthcare systems worldwide due to the extensive resources needed for hospital care and the high probability of subsequent readmissions. Existing international guidelines advocate for loop diuretics as a quick solution to ease breathing and manage fluid overload. Yet, discrepancies in dosing and administration routes highlight a pressing gap in evidence-based treatment options.

Expert Insights Point to a Grim Future

GlobalData's key opinion leader weighed in on the alarming trend: “The rehospitalization rate among elderly patients continues to rise. A typical patient finds themselves admitted more than once. I anticipate that the total number of hospitalized patients could more than double in the coming years.” This stark warning underscores the urgent need for effective therapies and strategies in managing acute heart failure.