# Impact of Sodium-Glucose Co-transporter 2 Inhibitors After Discharge in Patients With Heart Failure With Reduced Activities of Daily Living: A Single-Center Retrospective Cohort Study

## TL;DR

This study examines how SGLT2 inhibitors affect heart failure patients with reduced daily living activities after hospital discharge, finding mixed outcomes in frail individuals.

## Contribution

The study provides new evidence on the efficacy of SGLT2 inhibitors in heart failure patients with reduced activities of daily living post-hospitalization.

## Key findings

- SGLT2 inhibitors increased readmission rates in frail patients before adjustment for confounders.
- After adjustment, SGLT2 inhibitors showed mixed effects, reducing HF-specific but increasing overall readmissions in frail patients.
- Frailty and SGLT2 inhibitor use significantly influenced hospitalization outcomes.

## Abstract

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors benefit patients with heart failure (HF) with reduced ejection fraction (HFrEF), as well as preserved EFs (HFpEF). Frailty increases the risk of treatment intolerance and adverse events. SGLT2 inhibitors have demonstrated cognitive and clinical benefits, even in cases of severe frailty. However, there is limited evidence regarding its effects post-hospitalization in patients with reduced activities of daily living (ADL). This study investigated whether declining ADL affects SGLT2 inhibitor efficacy in reducing one-year all-cause and HF-specific readmissions.

Methods: This single-center, retrospective cohort study analyzed patients with HF admitted to Kameda General Hospital from December 2020 to February 2022. Eligible patients were discharged without major interventions and were stratified into four groups based on frailty (Barthel Index (BI): < 85) and whether they were prescribed an SGLT2 inhibitor at discharge. Demographic data, comorbidities, laboratory results, medications, and echocardiographic findings were collected. The primary endpoint was one-year HF rehospitalization, while secondary endpoints included all-cause hospitalization and mortality. One-way analysis of variance and chi-square (χ²) tests were used to compare group differences, and logistic regression with inverse probability of treatment weighting (IPTW) was applied to adjust for confounders.

Results: We analyzed 188 patients with HF after excluding 81 based on the eligibility criteria. Patients were stratified into frail (BI < 85, n = 78) and non-frail (BI ≥ 85, n = 110) groups, with the further subdivision based on SGLT2 inhibitor prescription. The frail group was older and had lower renal function, whereas the non-frail group had higher hemoglobin A1c levels and often lived alone. In unadjusted results, SGLT2 inhibitors increased the readmission rate in frail patients. After IPTW adjustment to reduce bias, the results aligned with the unadjusted findings, confirming that frailty and SGLT2 inhibitors significantly influenced outcomes, with a standardized mean difference imbalance in selected variables.

Conclusions: The findings of this study support the cautious use of SGLT2 inhibitors in patients with HF with a BI < 85 at discharge. While these drugs reduced HF rehospitalization in patients with frailty, they also increased the overall rehospitalization rate, likely due to their side effects.