Outcomes of sodium-glucose co-transporter type 2 inhibitors use in elderly patients with heart failure with reduced ejection fraction

Abstract

Abstract Background Heart failure is a highly prevalent condition, especially in patients over 75 years. In recent years, new therapeutic lines have emerged for the management of heart failure with reduced ejection fraction (HFrEF), most notably sodium-glucose co-transporter type 2 inhibitors (iSGLT2). However, there are currently low evidence of the benefit in this subgroup. Methods A retrospective study was conducted from January 2016 to December 2020 in our hospital. All patients aged ≥75 years, diagnosed with HFrEF (defined by left ventricular ejection fraction <40%), and current guidelines recommendations for iSGLT2 were included. Clinical, electrocardiographic and echocardiographic data were collected. Results A total of 616 patients were included, with a mean age at the inclusion of 83.3 years (standard deviation, SD, ± 5); 65.6% of the patients included were male. 81.2% were hypertensive, 35.4% were diabetic. 46.2% had chronic kidney disease (defined as glomerular filtrate <60mL/min/1.73 m2). Chronic lung disease was present in 14.8% of the patients, 16.2% had a history of cerebrovascular events and 12.7% suffered from peripheral vascular disease. The most frequent cause of HFrEF was ischemic, with 53.9%. A total of 86.8% presented a NYHA I-II; in 60.3% of the subjects, the rhythm at inclusion was sinus rhythm. The percentage of patients with BB was 76.9%, with ACEI / ARB 69.8%, 14.3% with ARNI and with anti-aldosterone agents 40.4%. The percentage of patients with SGLT2i was only 4.2%. The median follow-up was 34.5 months, during which 50.4% of the population died and 62.5% had a cardiovascular event (death or hospitalization for heart failure). A survival analysis using Cox regression showed that SGLT2i in this subgroup of patients was a protective factor against mortality (HR 0.124; 95% CI 0.031–0.497) and cardiovascular events (HR 0.428; 95% CI 0.221–0.830) Conclusion Despite current recommendations in the guidelines, there is marked underuse in elderly patients of SGLT2i. This could be related to greater intolerance or contraindication, but also to a lesser application of the clinical evidence in this population group. However, the use of SGLT2i has been shown as a significant factor associated with improved survival and comorbidity rate in our study population. Funding Acknowledgement Type of funding sources: None.