Efficacy and safety of SGLT2 inhibitors in heart failure: real-world evidence in geriatric patients

Abstract Background and aims SGLT2i have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited. This study aimed to assess the real-world efficacy and safety of SGLT2i in older patients with HF. Methods This prospective multicenter study included 496 patients hospitalized for acute heart failure across three geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.21. 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, AHF hospitalizations, and adverse events over one year. Results The SGLT2i group had significantly lower all-cause mortality (HR 0.61, p=0.002) and AHF hospitalizations (HR 0.54, p0.001) compared to the control group. Adjusted analyses confirmed these benefits, especially in HFpEF (aHR 0.47, p0.001). Although the SGLT2i group had higher rates of urinary and genital infections, the treatment discontinuation rate was low (2.7%). Conclusion In geriatric HF patients, SGLT2i therapy was associated with substantial reductions in mortality and hospitalizations. The treatment was generally well tolerated, with an acceptable safety profile in this frail population.