Survival benefits of SGLT2 inhibitors in very elderly patients with heart failure with preserved ejection fraction
Y L Ge, H Wang, J F YangAbstract
Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a foundational therapy for heart failure with preserved ejection fraction (HFpEF). However, pivotal randomized clinical trials have predominantly underrepresented the elderly population, leaving the real-world efficacy of SGLT2i in this specific demographic uncertain.
Purpose
This study aimed to evaluate the association between SGLT2i use and clinical outcomes in very elderly patients with HFpEF.
Methods
We analyzed the data of the HFpEF patients whose age ≥80 years old in the China Cardiovascular Association (CCA) database-Heart Failure Centre Registry, in which patients hospitalized for heart failure from 572 Chinese hospitals were recruited from 2017 to 2021. Patients were categorized into SGLT2i users and non-users. Propensity score matching (PSM) was employed to achieve balance in baseline characteristics. The primary outcomes were all-cause mortality and cardiovascular (CV) mortality. The associations between SGLT2i use and outcomes were assessed using Cox regression analyses. Multiple sensitivity analyses, including inverse probability of treatment weighting (IPTW), were performed.
Results
The study population included 46733 patients (mean age 85 ± 4 years, 56.7% women). After PSM, SGLT2i use was associated with a significantly lower risk of all-cause death (Hazard Ratio [HR] 0.62; 95% Confidence Interval [CI] 0.52–0.73; P<0.001) and CV death (HR 0.73; 95% CI 0.59–0.90; P<0.001) compared with no SGLT2i use (Figure 1). Consistent findings were replicated in both IPTW-weighted Cox regression analyses and multivariable Cox regression models.
Conclusions
SGLT2i therapy was associated with profound reductions in all-cause and cardiovascular mortality in very elderly patients with HFpEF. These findings challenge age-related therapeutic nihilism and support the routine initiation of SGLT2i in the very elderly to improve survival.