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Published on: July 5, 2017

Clinical Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Among Older Patients Hospitalized for Heart

Nicholas Brownell1, Nicole Solomon2, Stephen J Greene2

  • 1Division of Cardiology David Geffen School of Medicine at University of California Los Angeles CA USA.

Journal of the American Heart Association
|May 14, 2026
PubMed

Insights

Sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduced mortality and readmissions in older patients hospitalized with heart failure with reduced ejection fraction (HFrEF). These findings support SGLT2 inhibitor use in routine clinical practice for this vulnerable population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits in patients with heart failure with reduced ejection fraction (HFrEF).
  • Previous trials focused on younger, outpatient populations, leaving effectiveness in older, hospitalized HFrEF patients in routine practice understudied.

Purpose of the Study:

  • To evaluate the effectiveness of SGLT2 inhibitors in older Medicare beneficiaries hospitalized for HFrEF.
  • To assess the association of SGLT2 inhibitor initiation with 30-day and 1-year all-cause mortality, all-cause readmission, and heart failure readmission.

Main Methods:

  • Retrospective analysis of Medicare beneficiaries aged ≥65 years hospitalized for HFrEF between July 2021 and June 2023.
  • Compared outcomes between patients initiated on SGLT2 inhibitors by discharge and those not prescribed the medication.
  • Utilized Cox regression and overlap weighting with propensity score estimates to assess the association between SGLT2 inhibitor use and outcomes.

Main Results:

  • SGLT2 inhibitor initiation was associated with a significant reduction in 1-year all-cause mortality (aHR, 0.76), all-cause readmission (aHR, 0.89), and HF readmission (aHR, 0.84).
  • These benefits were observed in a cohort of older patients (median age 77) hospitalized for HFrEF.
  • Findings remained consistent across diverse subgroups, including variations in age, sex, race, ethnicity, diabetes, chronic kidney disease, and left ventricular ejection fraction.

Conclusions:

  • Initiation of SGLT2 inhibitors by hospital discharge is independently associated with improved post-discharge outcomes for older patients hospitalized with HFrEF.
  • The study supports the use of SGLT2 inhibitors to enhance outcomes in elderly HFrEF patients within routine US clinical settings.
Abstract

Keywords:
comparative effectiveness researchheart failureheart failure, systolichospitalizationmortalityregistriessodium‐glucose transporter 2 inhibitors

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