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Real-World Association of SGLT2 Inhibitors with Mortality in Very Elderly Patients with HFrEF and CKD

Antonio José Bollas Becerra1, Marcelino Cortés García1,2, Jorge Balaguer Germán3

  • 1Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain.

Biomedicines
|May 27, 2026
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors may reduce mortality in elderly patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD). This real-world study found SGLT2 inhibition associated with lower all-cause mortality in this vulnerable population.

Area of Science:

  • Cardiology
  • Nephrology
  • Geriatrics

Background:

  • Heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) frequently coexist in elderly patients.
  • Limited evidence exists on targeted treatments for this specific demographic.
  • This study investigates the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors in this population.

Purpose of the Study:

  • To analyze the effect of SGLT2 inhibition on clinical outcomes in elderly patients with HFrEF and CKD.
  • To identify factors influencing mortality and major clinical events in this cohort.

Main Methods:

  • A single-center, real-world observational study.
  • Inclusion criteria: patients >75 years old with HFrEF, CKD, and indication for SGLT2 inhibitors.
  • Median follow-up of 39 months with multivariate Cox proportional hazards regression analysis.

Main Results:

  • 173 patients included (mean age 84.7 years, LVEF 29.5%, eGFR 45.9 mL/min/1.73 m²).
  • SGLT2 inhibition was a significant protective factor against all-cause mortality (HR 0.324 [0.117-0.894]).
  • Male sex, diabetes mellitus, and diuretic use were identified as risk factors for mortality and/or major clinical events.

Conclusions:

  • SGLT2 inhibitor treatment in elderly patients with HFrEF and CKD is associated with reduced all-cause mortality in a real-world setting.
  • Findings support the use of SGLT2 inhibitors in this high-risk population.
  • Further research may confirm these benefits and optimize treatment strategies.

Keywords:
chronic kidney diseaseelderlyheart failuremortalitysodium-glucose transporter 2 inhibitor

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