Influence of the PROFUND index on the effectiveness of SGLT2 inhibitors in elderly pluripathological patients with acute heart failure: PROFUND-IC registry

BACKGROUND AND AIMS: The PROFUND index is a useful tool for estimating one-year mortality in pluripathological patients with heart failure, although its influence on the treatments administered remains unknown. The objectives of the present study were to evaluate whether the PROFUND index influences the effectiveness of sodium-glucose cotransporter type II inhibitors (SGLT2i), and to describe the differential characteristics of pluripathological patients with acute heart failure (AHF) according to this scale. METHODS: Retrospective study of 880 pluripathological patients with AHF from the PROFUND-IC registry, divided into three groups according to PROFUND index: low (0-2 points), medium (3-6) and high/very high mortality risk (≥7). A descriptive and comparative analysis was performed using the Chi-square test for qualitative variables and ANOVA for quantitative ones, (Fisher and Kruskal-Wallis, when indicated). Propensity Score Matching (PSM) was applied to minimize confounding factors. Kaplan-Meier curves were constructed analysing readmissions and mortality according to SGLT2i administration. RESULTS: 880 patients were included, 16.3% with low risk; 39.7% with medium risk and 44.1% with high/very high risk. Those with PROFUND index≥7 were predominantly women (61.3%, p=0.006), older, with worse functional class, lower Barthel index, and higher one-year mortality (p<0.001). SGLT2i administration appears to reduce readmissions among patients with PROFUND index between 3 and 6 (25.5% vs. 38.3%, p=0.02). After PSM, this trend persisted (24.1% versus 36.1%), without reaching statistical significance (p=0.065). CONCLUSIONS: SGLT2i appear beneficial in pluripathological patients with AHF, although the greatest impact is observed in PROFUND 3-6. Further studies are needed to clarify how comorbidity and functionality influence the effectiveness of these drugs.