Efficacy and Safety of Dapagliflozin in Patients Over 75 Years Old With Heart Failure With Preserved Ejection Fraction: A Retrospective Study

Aims/Background: Heart failure with preserved ejection fraction (HFpEF) poses therapeutic challenges, especially among the elderly. Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, has potential benefits beyond glucose regulation, including possible cardioprotective effects. This study evaluates the efficacy and safety of dapagliflozin in patients over 75 years old with HFpEF. Methods: This retrospective cohort study included 215 patients over 75 years old with HFpEF, divided into a standard treatment group (known as routine group, n = 105) and a dapagliflozin plus standard treatment group (known as dapagliflozin group, n = 110). Key assessments included Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, Six-Minute Walk Test (6MWT), echocardiographic parameters, adverse events, and biochemical markers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP), alongside patients’ satisfaction with the treatment administered. Results: The dapagliflozin group showed significant improvements in KCCQ Overall Summary Score (72.48 ± 12.49 vs 68.59 ± 13.11, p = 0.027) and 6MWT distance (358.47 ± 28.62 m vs 311.69 ± 30.26 m, p < 0.001) compared to the routine group. NT-proBNP and BNP levels showed significantly greater reductions in the dapagliflozin group (p = 0.046 and p = 0.039, respectively). Echocardiographic parameters indicated favorable cardiac remodeling. Incidence of adverse events was similar between groups, with no increase in serious renal or metabolic events in the dapagliflozin group. Dapagliflozin significantly improves patients’ satisfaction in elderly patients with HFpEF (p = 0.041). Conclusion: Dapagliflozin administration in HFpEF patients over 75 years significantly enhances cardiac function and exercise capacity, as well as improves quality of life markers, without notable safety concerns.