One-year maintenance of SGLT2 inhibitor therapy in octogenarians following acute heart failure with preserved or mildly reduced ejection fraction
S Valdivielso, M Cainzos-Achirica, L C Belarte-Tornero, M Vicente-Elcano, B Ayala-Borges, J Vime-Jubany, N Badosa-Merce, A Linas Alonso, P Ruiz Rodriguez, F Martinez Medina, I Garcia-Nunez, G Torres-Padilla, C Loaiza-Herrera, A Miralles-Morante, S Ruiz-BustilloAbstract
Background/Introduction
Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated significant benefits in patients with heart failure (HF). However, there is a lack of evidence on the use of SGLT2 inhibitors of elderly patients in real-world settings. Understanding treatment maintenance in this vulnerable population is essential to optimize clinical outcomes.
Purpose
Evaluation of one-year tolerability and continuation of SGLT2 inhibitor therapy in octogenarians following hospitalizarion for acute HF with mildly reduced or preserved ejection fraction (EF).
Methods
We prospectively included 285 patients aged ≥80 years with EF>40% after an episode of heart failure requiring hospitalization between July 2018 and June 2025 (N=285). Complete 12-month follow-up data were available for 233 patients. SGLT2i use at discharge and at 12 months was recorded, and maintenance was defined as the proportion of patients continuing therapy at one year. Reasons for treatment discontinuation were documented.
Results
Among the 233 patients with 12-month follow-up, 102 (43.8%) were prescribed SGLT2i at discharge. The cohort was predominantly female (62.7%), with a high prevalence of hypertension (83.6%), dyslipidemia (61.8%), and diabetes mellitus (37.7%). Chronic kidney disease was present in 47.9% (mean eGFR 47.7 ± 19.1 mL/min/1.73 m²). Cardiac comorbidities were frequent, including atrial fibrillation (63.2%), ischemic heart disease (26.9%), and prior heart failure (50.5%). Mean left ventricular ejection fraction was 58.9 ± 7.86%.
At 12 months, 98 of 102 patients (96.1%) remained on SGLT2i treatment. Of the 131 patients not on SGLT2i at baseline, 16 (12.2%) started therapy within 12 months Reasons for discontinuation were deterioration of renal function (1 patient), fungal genital infection (1 patient), urinary tract infection (1 patient), and unknown reason (1 patient).
Conclusions
In patients aged ≥80 years, initiation of SGLT2i at discharge after acute HF is associated with a high rate of one-year treatment maintenance. Advanced age alone should not be considered a barrier to SGLT2i therapy, supporting their use in elderly HF patients in routine clinical practice.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.