Sodium-glucose cotransporter-2 inhibitor users vs non-users had a lower risk of 1-year all-cause mortality [HR, 95% confidence interval (CI) = 0.75, 0.69-0.83], all-cause hospitalizations (HR, 95% CI = 0.86, 0.83-0.91), and emergency department visits (HR, 95% CI = 0.91, 0.86-0.96).<h4>Conclusion</h4>In this large multinational real-world data of patients with HFrEF, the prescription rate for SGLT2is within 6 weeks after the first HF hospitalization remained low. This evidence concerns the gene SLC5A2 and hydrops fetalis.