Clinical Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Among Older Patients Hospitalized for Heart Failure With Reduced Ejection Fraction.

BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2i) reduce cardiovascular events in randomized controlled trials of patients with heart failure with reduced ejection fraction (HFrEF), but these trials enrolled outpatient, relatively younger patients (median age 66-67). The effectiveness of SGLT2i in older patients hospitalized for HFrEF in routine US clinical practice is not well studied. METHODS: This study included Medicare beneficiaries aged ≥65 years hospitalized for HFrEF and eligible for SGLT2i in Get with the Guidelines-Heart Failure between July 1, 2021 and June 30, 2023. Primary outcomes were 30-day and 1-year all-cause mortality, all-cause readmission, and HF readmission. Association between SGLT2i and outcomes was assessed with Cox regression and overlap weighting using propensity score estimates. RESULTS: A total of 8847 patients were eligible for but not prescribed SGLT2i at hospital admission (Median age 77; 40% women; median left ventricular EF 28%); 1464 (16.5%) patients were initiated on SGLT2i by discharge. After overlap weighting, SGLT2i initiation was independently associated with lower all-cause mortality (adjusted hazard ratio [HR], 0.76 [95% CI, 0.67-0.86]), all-cause readmission (HR, 0.89 [95% CI, 0.81-0.97]), and HF readmission (HR, 0.84 [95% CI, 0.75-0.95]) over 12-month follow-up, compared with those not prescribed SGLT2i. Findings were consistent across subgroups based on age, sex, race, ethnicity, diabetes status, chronic kidney disease status, and left ventricular EF. CONCLUSIONS: Among older patients hospitalized for HFrEF, SGLT2i initiation by time of discharge was independently associated with reduced all-cause mortality, all-cause readmission, and HF readmission. These findings support SGLT2i use to improve postdischarge outcomes among older patients hospitalized for HFrEF in routine US practice.

Duke Scholars

Author Karen Chiswell  

Author Stephen Greene Medicine, Cardiology

Author Nicole Solomon