Real-world treatments and outcomes in very old patients with heart failure with preserved ejection fraction
A HacilAbstract
Background
Heart failure with preserved ejection fraction (HFpEF) is prevalent in geriatric populations, but evidence for sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients over 90 years old is limited. This study evaluated the real-world impact of SGLT2i in very old HFpEF patients by investigating factors associated with mortality or heart failure (HF) rehospitalizations.
Methods
This prospective multicenter study included 298 consecutive patients (mean age: 90 years, mean Charlson score: 8.29) admitted with acute HFpEF to three geriatric units in France, between April 2021 and July 2023. Demographics, comorbidities, and discharge medications were collected. The primary outcome was a composite of all-cause mortality or HF rehospitalization at one year. Multivariate Cox regression analysis was used to identify factors associated with the composite outcome.
Results
At discharge, 49.6% received SGLT2i. One-year mortality was 28.1%, and the HF rehospitalization rate was 22.8%. SGLT2i use significantly reduced the composite outcome risk (HR: 0.43; 95% CI: 0.29–0.66), with event rates of 29.7% in the SGLT2i group versus 56.6% without (p < 0.001). Renin-angiotensin system blockers also showed a significant risk reduction (HR: 0.56; 95% CI: 0.38–0.82). Severe malnutrition, hypertension, and high intravenous furosemide doses were associated with worse outcomes.
Conclusion
This study provides robust observational evidence supporting the use of SGLT2i therapy in very old HFpEF patients with high comorbidity burdens. Advanced age and multimorbidity should not preclude SGLT2i therapy in this population.