What is the clinical evidence from this study?

Study design: Observational. Population: Heart Failure with Reduced Ejection Fraction (HFrEF) (n=8847). Intervention: SGLT2 inhibitors vs. Not prescribed SGLT2 inhibitors. Primary outcome: 30-day and 1-year all-cause mortality, all-cause readmission, and HF readmission (HR 0.76, 95% CI 0.67-0.86).

What question did this study set out to answer?

This study aims to evaluate the effectiveness of SGLT2 inhibitors among older patients hospitalized for heart failure with reduced ejection fraction.

May 16, 2026Open Access

Clinical Effectiveness of Sodium‐Glucose Cotransporter‐2 Inhibitors Among Older Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

Key Result

SGLT2i initiation by discharge among older patients hospitalized for HFrEF was associated with lower 12-month all-cause mortality (HR 0.76; 95% CI 0.67-0.86) and HF readmission (HR 0.84).

Key Points

This study aims to evaluate the effectiveness of SGLT2 inhibitors among older patients hospitalized for heart failure with reduced ejection fraction.
Included Medicare beneficiaries aged ≥65 years hospitalized for heart failure between July 2021 and June 2023.
Evaluated outcomes such as all-cause mortality and readmissions using Cox regression and overlap weighting.
Total of 8847 patients eligible for but not prescribed SGLT2 inhibitors at admission.
SGLT2i initiation was associated with lower all-cause mortality (HR 0.76, 95% CI 0.67–0.86).
Lower all-cause readmission observed (HR 0.89, 95% CI 0.81–0.97).
HF readmissions also reduced (HR 0.84, 95% CI 0.75–0.95) over 12-month follow-up.

Study Design

Type

Observational (n=8,847)

Multicenter

Yes

Structured PICO

Does SGLT2 inhibitor initiation by hospital discharge reduce mortality and readmissions in older patients hospitalized for HFrEF?

Population

8,847 Medicare beneficiaries aged ≥65 years hospitalized for HFrEF (median LVEF 28%), median age 77, 40% women, in the US Get with the Guidelines–Heart Failure registry.

Intervention

SGLT2 inhibitors initiated by hospital discharge

Comparator

Not prescribed SGLT2 inhibitors at hospital discharge

Outcome

30-day and 1-year all-cause mortality, all-cause readmission, and HF readmissionhard clinical

Initiation of SGLT2 inhibitors by hospital discharge in older, real-world Medicare patients with HFrEF is associated with significantly reduced 1-year all-cause mortality and readmissions.

Main Result

Effect estimate: HR 0.76 (95% CI 0.67-0.86)

Abstract

Background SGLT2 (sodium‐glucose cotransporter‐2) inhibitors (SGLT2i) reduce cardiovascular events in randomized controlled trials of patients with heart failure with reduced ejection fraction (HFrEF), but these trials enrolled outpatient, relatively younger patients (median age 66–67). The effectiveness of SGLT2i in older patients hospitalized for HFrEF in routine US clinical practice is not well studied. Methods This study included Medicare beneficiaries aged ≥65 years hospitalized for HFrEF and eligible for SGLT2i in Get with the Guidelines–Heart Failure between July 1, 2021 and June 30, 2023. Primary outcomes were 30‐day and 1‐year all‐cause mortality, all‐cause readmission, and HF readmission. Association between SGLT2i and outcomes was assessed with Cox regression and overlap weighting using propensity score estimates. Results A total of 8847 patients were eligible for but not prescribed SGLT2i at hospital admission (Median age 77; 40% women; median left ventricular EF 28%); 1464 (16.5%) patients were initiated on SGLT2i by discharge. After overlap weighting, SGLT2i initiation was independently associated with lower all‐cause mortality (adjusted hazard ratio HR, 0.76 95% CI, 0.67–0.86), all‐cause readmission (HR, 0.89 95% CI, 0.81–0.97), and HF readmission (HR, 0.84 95% CI, 0.75–0.95) over 12‐month follow‐up, compared with those not prescribed SGLT2i. Findings were consistent across subgroups based on age, sex, race, ethnicity, diabetes status, chronic kidney disease status, and left ventricular EF. Conclusions Among older patients hospitalized for HFrEF, SGLT2i initiation by time of discharge was independently associated with reduced all‐cause mortality, all‐cause readmission, and HF readmission. These findings support SGLT2i use to improve postdischarge outcomes among older patients hospitalized for HFrEF in routine US practice.