Effect of sodium–glucose cotransporter 2 inhibitors on heart failure readmission in older patients with diabetes: A Japanese claims‐based cohort study

AIMS: To evaluate the effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) administration at hospital discharge on heart failure (HF) readmission among older patients (≥75 years) with HF and diabetes and to compare the effectiveness of four SGLT2is, namely, ipragliflozin, empagliflozin, canagliflozin, and dapagliflozin, with a focus on direct head-to-head comparisons among individual SGLT2is. MATERIALS AND METHODS: We conducted a retrospective cohort study using the Medical Data Vision claims database. We included 66,895 patients aged ≥75 years who were emergently hospitalized for HF with comorbid diabetes between 2018 and 2022. Patients were categorized according to SGLT2i administration at discharge. Propensity score matching (PSM) was applied to adjust for baseline characteristics. The primary outcome was HF readmission, assessed using Kaplan-Meier analysis and Cox proportional hazards models. Inverse probability of treatment weighting (IPTW) was used to compare the four SGLT2is. RESULTS: After PSM, SGLT2i users showed a significantly lower risk of HF readmission than nonusers (hazard ratio HR 0.91, 95% confidence interval CI: 0.85-0.97, P = 0.003). Sensitivity analysis censoring death and treatment discontinuation or initiation produced consistent results (HR 0.79, 95% CI: 0.74-0.85, P < 0.001). An IPTW-based comparison of the four agents revealed no significant differences, suggesting similar class-wide effectiveness. CONCLUSIONS: Among older patients with HF and diabetes, SGLT2i administration was associated with reduced HF readmission risk, with no meaningful differences among the four agents. These findings support a class-wide effect of SGLT2i and highlight the importance of their appropriate initiation and continuation in older adults.