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Sodium glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve the prognosis of heart failure with preserved ejection fraction (HFpEF) in phase 3 randomized controlled trials (RCTs). However, a granular definition of HF was adopted only in the most recent RCTs (hereafter, HF RCTs). In earlier studies, which assessed cardiovascular (CV) outcomes in patients with type 2 diabetes (CV outcomes trials, CVOTs), HF status was assigned based on medical history.

We searched for RCTs evaluating SGLT2i vs placebo in HFpEF and published from inception to Aug. 31^st 2022, irrespective of whether additional criteria were used to define HFpEF besides left ventricular ejection fraction ≥50%. Heterogeneity between studies was examined by the Cochran's Q test and Higgins and Thompsons’ I² statistics. Risk ratios (RRs) with 95% confidence …