Early initiation of SGLT2-inhibitors and changes in physical function in elderly patients hospitalized for heart failure

Background and purpose

It has been reported that the Barthel Index (BI) at discharge greatly influences the prognosis of hospitalized heart failure (HHF) patients one year after discharge. SGLT2-inhibitors have been shown to improve the prognosis of heart failure patients regardless of left ventricular ejection fraction, but there are concerns about their safety in low-weight elderly patients due to concerns that SGLT2-inhibitors themselves may worsen sarcopenia. We previously reported that the use of SGLT2-inhibitors in HHF patients was associated with preserved BI regardless of thier body mass index (BMI) , and earlier initiation of SLGT2-inhibitors was associated with greater BI preservation. This time, we examined whether similar effects could be observed specifically in elderly hospitalized patients with heart failure.

Method

We retrospectively examined 52 HHF patients aged 75 and older who were hospitalized in our hospital from January to September 2023, focusing on the use of SGLT2-inhibitors and changes in BI during hospitalization.

Results

Their mean age was 87±6 years, the mean BMI was 22.5±4.2 at admission and 20.5±4.2 at discharge, the mean length of hospital stay was 18±14 days, and SGLT2-inhibitors were used in 34 patients (65%). In all patients, the decrease in BI during hospitalization was significantly smaller in SGLT2-inhibitor-users than in SGLT2-inhibitors-non-users (-9.3±16.9 vs -20.3±18.7, p<0.05). Among non-obese-patients (BMI<25, n=38), SGLT2-inhibitor-users (n=26) had significantly higher BI at discharge than non-users (64.8±30.0 vs. 27.7±24.2, p<0.01), and the decrease in BI was also significantly smaller (-8.6±18.0 vs -23.6±21.2, p<0.05). Even among patients with low-body-weight (BMI<18.5, n=19), the BI at discharge was significantly higher in SGLT2-inhibitor-users (n = 11) than in non-users (53.6 ± 32.5 vs. 28.8 ± 26.4, p<0.05), and the decrease in BI tended to be smaller (-12.3±12.5 vs -16.9±20.9, p=0.56).

Of the 34 patients who were taking SGLT2-inhibitors, 27 (79%) started taking them on the first or second day of admission. Among patients taking SGLT2-inhibitors, the later they started taking SGLT2-inhibitors, the greater the decrease in BI during hospitalization (p<0.05).

There was no significant difference in the duration of continuous intravenous infusion or oxygen administration between users and non-users of SGLT2-inhibitors. The duration of bladder catheters was significantly shorter in SGLT2-inhibitors-users than in SGLT2-inhibitors-non-users (3.5±3.5 vs 7.2±6.7 days, p<0.01).

Conclusion

Consistent with previous reports, in elderly HHF patients, the use of SGLT2-inhibitors was associated with preservation of BI during hospitalization, and earlier initiation of SLGT2-inhibitors was associated with greater BI preservation. The use of SGLT2-inhibitors was associated with shorter durations of indwelling bladder catheters, which may have helped shorten the duration of bed rest.