Key result
SGLT2 inhibitors reduce CV death and HF hospitalization vs placebo in older adults with HFpEF.
Why the study?
Older adults aged ≥ 60 years have a higher prevalence of HFpEF and face increased risk of adverse treatment effects due to age-related changes, comorbidities, polypharmacy, and frailty, while data on new therapies in older patients remain lacking.
Older adults with HFpEF require careful application and monitoring of guideline-directed medical therapies due to increased susceptibility to adverse effects from age-related vulnerabilities.
Supports SGLT2i use with careful monitoring in older HFpEF; extends RCT evidence to mean age 72 despite vulnerabilities.
The prevalence of heart failure with preserved ejection fraction (HFpEF) is greater in adults aged ≥ 60 years than in the general population; however, these patients are also at a greater risk of adverse effects from treatments for HFpEF, due to age-related physiological changes, comorbidities and conditions such as polypharmacy and frailty. Guideline-directed medical therapies recommend the use of loop diuretics and sodium‑glucose co‑transporter‑2 inhibitors for most patients. Some guidelines also carry recommendations for treating some patients with HFpEF with mineralocorticoid receptor agonists, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors, although evidence supporting their benefit is weaker. Several new drugs are showing promise for the treatment of HFpEF, but data are lacking in older patients.
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Aisling McGuigan (2026) conducted a review in Older adults aged ≥60 years with heart failure with preserved ejection fraction (HFpEF). SGLT2 inhibitors dapagliflozin and empagliflozin reduced the composite of cardiovascular death and hospitalisation for heart failure significantly compared to placebo in older adults with HFpEF (mean age 72 years).
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