Background: Observational studies and small randomized controlled trials have suggested the benefits of early introduction of sodium–glucose cotransporter 2 inhibitors (SGLT2is) in acute heart failure (AHF). However, current evidence on their efficacy and safety in this clinical setting remains limited. Methods: We performed a systematic review and meta‐analysis to assess efficacy/safety of early use of SGLT2is in AHF. PUBMED/EMBASE/Cochrane were searched from inception to May 31, 2024, for randomized controlled trials evaluating outcomes of SGLT2i early initiation in patients with AHF. Efficacy outcomes were all‐cause death and heart failure rehospitalizations. Safety outcomes included acute kidney injury, ketoacidosis, urinary tract infections, hypotension, and hypoglycemia. Early initiation was defined as performed before or shortly after discharge (within 3 days). A sensitivity analysis was conducted, including only patients with initiation before discharge. Results: Seven randomized controlled trials that enrolled 2320 patients were included. Early use of SGLT2is was associated with a significant reduction in all‐cause death (odds ratio, 0.71 [95% CI, 0.55–0.92; 95% PI, 0.55–0.98]) and HF rehospitalizations (odds ratio, 0.73 [95% CI, 0.57–0.94; 95% PI, 0.58–0.93]), even after adjusting for follow‐up duration. SGLT2i initiation before discharge yielded consistent results for efficacy outcomes. Safety outcomes could not be usefully determined because of a low events rate resulting in wide CIs. The impact of diabetic status remains basically unknown due to the small number of available randomized controlled trials investigating this population. Conclusions: Early introduction of SGLT2is in AHF improves all‐cause death and rehospitalization rates, can be performed before discharge, and should be offered to most patients with AHF.

Aims: Ventricular arrhythmias (VAs) occur frequently following left ventricular assist device (LVAD) implantation. However, current evidence regarding their true incidence and impact remains limited. Methods and results: We performed a systematic review and meta-analysis to assess the incidence and impact of post-LVAD VAs. PubMed/Embase/Cochrane databases were searched from inception to 1 April 2025, for studies reporting the occurrence of VAs following LVAD implantation. The primary outcome was the overall incidence of VAs. Secondary outcomes included the incidence of early (≤30 days) and late (>30 days) VAs, as well as electrical storm (ES) and their impact on all-cause mortality, assessed using incidence rate ratios (IRRs). Forty studies including 22 181 patients were analysed. The overall incidence of post-LVAD VAs was 2.43 (1.70–3.48) events per 100 person-months. Ventricular arrhythmia occurrence was significantly associated with increased all-cause mortality [IRR 1.32 (1.11–1.57)). The incidence of early VAs was 0.65 (0.48–0.88) events per 100 person-days (19.5 events per 100 patients over 30 days), and early VAs were associated with a higher risk of mortality [IRR 1.40 (1.18–1.67)]. Conversely, the incidence of late VAs was 2.05 (1.43–2.93) events per 100 person-months and was not significantly associated with mortality [IRR 0.85 (0.66–1.10)]. Electrical storm incidence was 0.44 (0.07–2.71) events per 100 person-months, significantly increasing all-cause mortality [IRR 1.34 (1.01–1.79)]. Conclusion: Ventricular arrhythmias are frequent following LVAD implantation and are associated with a significant impact on all-cause mortality—particularly when occurring early after implantation. Further studies are needed to optimize VA management and implantable cardioverter-defibrillator use.

Background: Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs. Methods: FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. Our aim was to compare outcomes (1-month and 1-year all-cause mortality) between CS patients taking and those not taking BBs in three scenarios: (1) at 24 h after CS; (2) patients who did or did not discontinue BBs within 24 h; and (3) patients who did or did not undergo the early introduction of BBs. Results: Among the 693 CS included, at 24 h after the CS event, 95 patients (13.7%) were taking BB, while 598 (86.3%) were not. Between the groups, there were no differences in terms of major comorbidities or initial CS triggers. Patients receiving BBs at 24 h presented a trend toward reduced all-cause mortality both at 1 month (aHR = 0.61, 95% CI 0.34 to 1.1, p = 0.10) and 1 year, which was, in both cases, not significant. Compared with patients who discontinued BBs at 24 h, patients who did not discontinue BBs showed lower 1-month mortality (aHR = 0.43, 95% CI 0.2 to 0.92, p = 0.03) and a trend to lower 1-year mortality. No reduction in outcomes was observed in patients who underwent an early introduction of BB therapy. Conclusions: BBs are drugs of first choice in patients with HF and should also be considered early in patients with CS. In contrast, the discontinuation of BB therapy resulted in increased 1-month all-cause mortality and a trend toward increased 1-year all-cause mortality.

Aims: Although predominant in routine practice, non-ischaemic cardiogenic shock (NICS) remains underrepresented in past studies, mainly focused on ischaemic cardiogenic shock (CS). This study aims to describe the current NICS picture and define its independent correlates of short- and long-term outcomes. Methods and results: FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. One-year mortality was the primary outcome. One-month mortality and the composite of 1-year mortality, heart transplantation (HTx), or ventricular assistance device (VAD) were secondary outcomes. Within 772 patients included, 492 (63.7%) were NICS. One-month and 1-year mortality rates were 25.6% and 45.7%, with a combined endpoint of 1-year mortality, HTx, or VAD of 53.9%. Multivariate analysis showed five independent factors for 1-year mortality: age (per year: aHR 1.03 [1.01–1.05], P < 0.01), chronic kidney disease (CKD) (aHR 1.87 [1.25–2.80], P < 0.01), norepinephrine use (aHR 1.52 [1.02–2.26], P = 0.04), active cancer (aHR 1.91 [1.07–3.42], P = 0.03) and acute renal replacement therapy (aHR 1.57 [1.01–2.46], P = 0.049). Age, CKD and norepinephrine were also predictive of 1-month mortality and 1-year mortality and/or HTx and/or VAD. Additionally, 1-month mortality was associated with septic triggers, and 1-year mortality and/or HTx and/or VAD with acute mechanical circulatory support, NYHA stage ≥ 3 and fluid administration. Conclusions: In this large study, NICS accounted for almost two-thirds of all CS cases, with substantial rates of short- and long-term mortality. Future studies should evaluate interventions to improve early stratification and management. NCT02703038.