Efficacy and Safety of SGLT2 Inhibitors in Heart Failure: Observational Evidence in Geriatric Patients—AGING-HF
Abdelhakim Hacil, Yara Antakly Hanon, Audrey Lacour, Jean‐Philippe David, T.A.A. Khalifa, Matthieu Piccoli, Aude Clemencin, Patrick Assayag, Jean‐Sébastien Vidal, Olivier Hanon
Abstract
Abstract Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited. This observational study aimed to assess the real-world efficacy and safety of SGLT2i in elderly patients with HF. Methods This prospective multicenter study included 496 patients hospitalized for acute heart failure (AHF) across three geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.2. Participants were divided into two groups: the "SGLT2i group" (n=260) receiving SGLT2i (empagliflozin or dapagliflozin) alongside standard HF treatment, and the "Control group" (n=236) receiving only standard HF treatment. The primary outcomes were all-cause mortality, HF rehospitalizations, and adverse events over one year. Results SGLT2i use was associated with lower risks of all-cause mortality (HR 0.67 [95% CI 0.46–0.98], p=0.031), HF rehospitalization (HR 0.64 [95% CI 0.42–0.97], p=0.037), and the composite outcome (HR 0.60 [95% CI 0.44–0.82], p=0.001) at one year, after multivariable adjustment. No significant interaction was observed between LVEF status and SGLT2i use (p for interaction = 0.12). Although urinary and genital infections were more frequently reported in the SGLT2i group, treatment discontinuation remained low (2.7%). Conclusion In this very elderly population with high comorbidity, SGLT2i therapy was associated with substantial reductions in mortality and HF rehospitalization and showed good tolerability and an acceptable safety profile.