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- Title
Clinical benefits of empagliflozin in very old patients with type 2 diabetes hospitalized for acute heart failure.
- Authors
Pérez‐Belmonte, Luis M.; Sanz‐Cánovas, Jaime; Millán‐Gómez, Mercedes; Osuna‐Sánchez, Julio; López‐Sampalo, Almudena; Ricci, Michele; Jiménez‐Navarro, Manuel; López‐Carmona, Maria D.; Bernal‐López, María Rosa; Barbancho, Miguel A.; Lara, José P.; Gómez‐Huelgas, Ricardo
- Abstract
Background: There is little evidence on the use of sodium−glucose cotransporter 2 (SGLT2) inhibitors in older patients with heart failure. This work analyzed the clinical efficacy and safety of empagliflozin continuation in very old patients with type 2 diabetes hospitalized for acute decompensated heart failure. Methods: We conducted a real‐world observational study between September 2015 and June 2021. Patients ≥80 years were grouped by antihyperglycemic regimen: (1) continuation of preadmission empagliflozin combined with basal insulin regimen and (2) conventional basal‐bolus insulin regimen. A propensity score matching analysis matched patients in both groups in a 1:1 manner. The primary outcome was differences in clinical efficacy measured by the visual analogue scale dyspnea score, NT‐proBNP levels, diuretic response, and cumulative urine output. Safety endpoints such as adverse events, worsening heart failure, discontinuation of empagliflozin, length of hospital stay, and in‐hospital deaths were also analyzed. Results: After propensity score matching, 79 patients were included in each group. At discharge, the N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels were lower in the empagliflozin continuation group than in the insulin group (1699 ± 522 vs. 2303 ± 598 pg/ml, p = 0.021). Both the diuretic response and cumulative urine output were greater in patients treated with empagliflozin than in patients with basal‐bolus insulin during the hospitalization (at discharge: −0.14 ± −0.06 vs. −0.24 ± −0.10, p = 0.044; and 16,100 ± 1510 vs. 13,900 ± 1220 ml, p = 0.037, respectively). No differences were observed in safety outcomes. Conclusions: In very old patients with type 2 diabetes hospitalized for acute heart failure, continuing preadmission empagliflozin reduced NT‐proBNP levels and increased diuretic response and urine output compared to a basal‐bolus insulin regimen. The empagliflozin regimen also showed a good safety profile.
- Subjects
OLDER people with diabetes; SODIUM-glucose cotransporters; DRUG efficacy; DIURETICS; SCIENTIFIC observation; EMPAGLIFLOZIN; URINE; TYPE 2 diabetes; INSULIN; HOSPITAL care; HEART failure; PHARMACODYNAMICS; DISEASE complications; OLD age
- Publication
Journal of the American Geriatrics Society, 2022, Vol 70, Issue 3, p862
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.17585