Association between SGLT2 inhibitor use and functional outcomes in elderly patients receiving ferric carboxymaltose: a retrospective observational cohort study

Anemia and iron deficiency (ID) are extremely common comorbidities in elderly patients with chronic heart failure (CHF), and are associated with reduced functional capacity and worse prognosis. The objective of this study was to evaluate the association of one-year therapy with SGLT2i as add-on to intravenous infusion of ferric carboxymaltose (FCM) with improvement in functional abilities, in a cohort of elderly patients with HFrEF/HFmrEF with ID anemia. This study enrolled outpatients with CHF with ID anemia receiving intravenous administration of FCM and stratified into two groups according to SGLT2i use. The study endpoint was an achievement of Short physical performance battery (SPPB)>8pt at one year of follow-up. 222 patients, with a mean age of 75.5±6.0 years were enrolled and 53 received SGLT2i while 169 not. After 1 year of follow-up, a significant improvement in the main clinical, laboratory, echocardiographic and CGA parameters were observed in both groups; however, these improvements were statistically greater in those patients receiving also SGLT2i. The mean dose of FCM administered to the entire population at baseline was 734.2 ± 331.7 mg, with no significant differences between the two groups (p=0.475). Add on therapy with SGLT2i was associated with a greater improvement in functional abilities (OR 7.66; CI 95% 3.70–15.9, p<0.0001), while the presence of obesity was associated with a reduced probability of functional abilities improvement of 68% (OR 0.32; CI 95% 0.14–0.71, p=0.005). In patients with CHF and ID anemia, improvements in clinical symptoms and physical function were observed at one-year follow-up, as reflected by changes in SPPB scores. These improvements were greater among patients receiving concomitant SGLT2i therapy.