Analysis of Medicare data from Get with the Guidelines-Heart Failure: 8,847 patients aged ≥65 years hospitalised for HFrEF between July 2021 and June 2023, eligible for SGLT2 inhibitors but not yet receiving them (median age 77 years, 40% women, median LVEF 28%). 16.5% (n=1,464) initiated an SGLT2 inhibitor at discharge. After overlap weighting via propensity score, SGLT2i initiation was independently associated with lower 12-month all-cause mortality (aHR 0.76; 95% CI 0.67-0.86), all-cause readmission (aHR 0.89), and HF readmission (aHR 0.84). Findings were consistent across age, sex, race/ethnicity, diabetes status, CKD status, and LVEF. Early in-hospital initiation of SGLT2 inhibitors thus improves prognosis in older HFrEF patients in routine practice — a population previously underrepresented in RCTs.
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.
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.
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.
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.
