Heart failure (HF) can be classified into ischemic and non-ischemic types based on etiology, with differences in their pathological basis and remodeling patterns. Since 2019, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown in numerous randomised controlled trials (RCT) to reduce the risk of HF getting worse and of cardiovascular events, with benefits that are not dependent on a person's diabetic status. This article systematically reviews evidence on the consistency of SGLT2i efficacy in ischemic and non-ischemic HF, potential sources of heterogeneity, and their multi-pathway cardio-renal-metabolic mechanisms. It discusses clinical integration strategies based on research progress in Chinese populations, with a focus on the latest findings and advancements in the field. Existing RCT subgroup analyses and meta-studies collectively indicate that SGLT2i significantly reduces HF hospitalization/worsening risk in both etiological groups, with most interaction tests showing no statistical significance. At the mechanism level, cross-etiological benefits may be achieved through common terminal pathways such as decongestion and glomerular hyperfiltration correction, myocardial energy metabolism improvement, ion homeostasis and inflammatory fibrosis inhibition. In the future, it is necessary to carry out prospective studies stratified by etiology under a unified and operable etiology determination framework, combining imaging and biomarkers to promote precise treatment.