{"id":"87ba765d89cd","type":"article","url":"https://hartvaat.nl/2026/05/19/sglt2-remmers-bij-oudere-patienten-opgenomen-voor-hfref-24-sterfte-en-16-heropna/","title":"SGLT2-remmers bij oudere patiënten opgenomen voor HFrEF: -24% sterfte en -16% heropname bij start vóór ontslag","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine"],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.126.049161","source_url":"https://doi.org/10.1161/JAHA.126.049161","authors":["Nicholas Brownell","Nicole Solomon","Stephen J Greene","Karen Chiswell","Muthiah Vaduganathan","Clyde Yancy","Priscilla Hsue","Boback Ziaeian","Gregg C Fonarow"],"significance":7,"published":"2026-06-15","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"Analysis of Medicare data from Get with the Guidelines-Heart Failure: 8,847 patients aged ≥65 years hospitalised for HFrEF between July 2021 and June 2023, eligible for SGLT2 inhibitors but not yet receiving them (median age 77 years, 40% women, median LVEF 28%). 16.5% (n=1,464) initiated an SGLT2 inhibitor at discharge. After overlap weighting via propensity score, SGLT2i initiation was independently associated with lower 12-month all-cause mortality (aHR 0.76; 95% CI 0.67-0.86), all-cause readmission (aHR 0.89), and HF readmission (aHR 0.84). Findings were consistent across age, sex, race/ethnicity, diabetes status, CKD status, and LVEF. Early in-hospital initiation of SGLT2 inhibitors thus improves prognosis in older HFrEF patients in routine practice — a population previously underrepresented in RCTs.","created":"2026-07-03T10:33:03Z","updated":"2026-07-03T13:31:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van Medicare-data uit Get with the Guidelines-Heart Failure: 8.847 patiënten ≥65 jaar opgenomen voor HFrEF tussen juli 2021 en juni 2023, die in aanmerking kwamen voor SGLT2-remmers maar deze nog niet gebruikten (mediane leeftijd 77 jaar, 40% vrouw, mediane LVEF 28%). 16,5% (n=1.464) startte SGLT2-remmer bij ontslag. Na overlap-weging via propensity score was SGLT2i-initiatie onafhankelijk geassocieerd met lagere 12-maands totale mortaliteit (aHR 0,76; 95%-BI 0,67-0,86), heropnames (aHR 0,89) en HF-heropnames (aHR 0,84). Bevindingen waren consistent over leeftijd, geslacht, etniciteit, diabetesstatus, CKD-status en LVEF. Vroege initiatie van SGLT2-remmers in het ziekenhuis verbetert dus de prognose bij oudere HFrEF-patiënten in routinepraktijk — een grijs gebied waarin RCT-data tot nu toe beperkt waren.","abstract_original":"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."}