Efficacy of sodium-glucose cotransporter 2 inhibitors for super-aged heart failure population

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are indicated for patients with all phenotypes of heart failure (HF). Despite the current unprecedented super-aged society in real-world settings, the efficacy of SGLT2 inhibitors in super-aged HF patients, especially those of ≥80 years, remains unknown.

This study was conducted across three hospitals in Japan, including 238 HF patients ≥80 years (mean 84.2 ± 3.3 years), who were treated with SGLT2 inhibitors (dapagliflozin or empagliflozin). SGLT2 inhibitors were used for HF, with preserved ejection fraction in 131 patients (55.0 %), mildly-reduced ejection fraction in 54 patients (22.7 %), and reduced ejection fraction in 53 patients (22.3 %). Among 238 patients, 191 (80.3 %) continued SGLT2 inhibitors, while 47 (19.7 %) discontinued SGLT2 inhibitors (for any reason) during follow-up. The primary outcome was a composite of cardiovascular death or worsening HF, with a median follow-up duration of 2.73 (2.08-3.52) years.

Cumulative incidence curves modified by the Simon-Makuch method with a time-varying Cox regression analysis showed that HF patients with continued SGLT2 inhibitor treatment had significantly favorable outcomes, which remained consistent after adjustment for baseline characteristics by propensity score matching, and discontinuation of SGLT2 inhibitors was the strongest contributing factor to the outcome by a multivariable analysis. Moreover, the multivariable analysis identified a higher clinical frailty scale score as an independent factor associated with discontinuation of SGLT2 inhibitors.

This study provides real-world evidence supporting the use of SGLT2 inhibitors in super-aged patients with HF, emphasizing the importance of appropriately assessing the continuation of SGLT2 inhibitors.