Comparison of prognosis among elderly heart failure patients with different degrees of frailty treated with Empagliflozin / 中华老年医学杂志

ABSTRACT

Objective:To evaluate the effect of Empagliflozin on the incidence of major adverse cardiovascular events(MACE)in elderly patients with heart failure and reduced ejection fraction(HFrEF)over a period of 1 year.Additionally, the study will analyze the influence of frailty on MACE.Methods:This study is a retrospective analysis of 577 elderly patients with type 2 diabetes and heart failure with reduced ejection fraction(HFrEF)who were consecutively admitted to Beijing Anzhen Hospital from January 2018 to December 2020.The patients were divided into three groups according to frailty index(FI): non-frailty(FI ≤ 0.210, 301 cases), moderate frailty(FI 0.211-0.310, 184 cases), and severe frailty(FI>0.311, 92 cases).Additionally, a control group of 300 elderly HFrEF patients with T2DM who did not receive Sodium glucose co-transporter type 2(SGLT-2)inhibitors was included.The MACE outcomes of different patient groups who were followed up for a year after discharge were compared.The composite outcomes of cardiac death, worsening heart failure readmission, non-fatal myocardial infarction, and non-fatal stroke were recorded and analyzed.The study also includes Cox regression analysis of relevant factors that may affect MACE outcomes.Results:A total of 877 patients were monitored for a period of 7-14 months, with a median follow-up duration of(11.4±2.3)months.Out of these patients, 47(5.4%)were lost to follow-up.During the follow-up period, 108 patients(18.7%)in the Empagliflozin group experienced major adverse cardiovascular events(MACE), which included 43 patients(7.5%)with heart failure readmission, 29 patients(5.0%)with non-fatal myocardial infarction, 23 patients(4.0%)with non-fatal stroke, and 13 patients(2.3%)with cardiovascular death.The control group had 73 cases of major adverse cardiac events(MACE), which included 33 cases(11.0%)of readmission due to heart failure, 18 cases(6.0%)of non-fatal myocardial infarction, 14 cases(4.7%)of non-fatal stroke, and 8 cases(2.7%)of cardiovascular death.The Kaplan-Meier survival analysis revealed significant differences in the risk of readmission for heart failure exacerbation and MACE among the groups.The study found that the Empagliflozin group had a significantly lower risk of MACE(18.7% vs.24.3%, HR=0.792, 95% CI: 0.639-0.982, P=0.033)compared to the control group.Additionally, as frailty level increased, the risk of MACE in each empagliflozin subgroup also increased significantly(14.6% vs.19.6% vs.30.4%, P<0.001).The moderate and severe frailty groups had a 1.342 times( HR=1.342, 95% CI: 1.116-1.768, P=0.022)and 1.933 times( HR=1.933, 95% CI: 1.207-3.854, P=0.019)higher risk of MACE compared to the non-frailty group.The study conducted a multivariate Cox regression analysis and found that several factors were independently associated with the risk of MACE, including age( HR=1.164), duration of heart failure( HR=1.225), B-type natriuretic peptide level( HR=1.221), albumin/creatinine ratio( HR=1.158), renin-angiotensin-aldosterone system blocker( HR=0.891), frailty index( HR=1.764), and empagliflozin( HR=0.792)( P<0.05 for all). Conclusions:Empagliflozin has been shown to reduce the risk of major adverse cardiovascular events(MACE)in patients with heart failure with reduced ejection fraction(HFrEF).However, it is important to note that the cardiovascular benefits of SGLT-2 inhibitors may be affected by frailty in elderly patients with heart failure.As frailty worsens, the risk of readmission and MACE may increase significantly.