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In Cox regression, patients with LV GLS -11% had a high risk of cardiovascular death. In patients with HFmrEF, LV GLS is associated with LVEF changes and subsequent cardiovascular death. Patients with HFrecEF had a lower risk of hospitalization for HF. In patients with HFmrEF, LV GLS is associated with LVEF changes and subsequent cardiovascular death. Patients with HFrecEF had a lower risk of hospitalization for HF. We studied the use of all hypoglycemic agents in periods before and after introduction of SGLT-2 inhibitors in the USA