Archives of Gerontology and Geriatrics · Jan 9, 2026

Clinical outcomes and safety of SGLT2 inhibitors in the older population with heart failure: A systematic review and meta-analysis

By Khalid A, Balach R, Rasool A et al.

BACKGROUND: Heart failure (HF) predominantly affects older adults, yet this group remains underrepresented in sodium-glucose cotransporter-2 inhibitor (SGLT2i) trials. Given their frailty and multimorbidity, clarifying the potential benefit and safety of SGLT2i in older HF patients is essential. METHODS: PubMed, ScienceDirect, and Cochrane Central were searched through August 2025 for randomized controlled trials (RCTs) and observational studies comparing SGLT2i with control in patients aged ≥65 years with HF. Hazard ratios (HRs), risk ratios (RRs), and mean differences (MDs) were pooled using random-effects models. RESULTS: Ten studies (4 RCTs, 6 cohorts; n = 20,844) were included. SGLT2i was associated with a lower hazard of all-cause mortality (HR 0.81 [95% CI 0.72-0.90]; p < 0.001), cardiovascular (CV) death (HR 0.83 [0.74-0.94]; p = 0.004), first HF hospitalization (HR 0.73 [0.66-0.80]; p < 0.001), composite CV death or HF hospitalization (HR 0.78 [0.70-0.87]; p < 0.001), and rehospitalization (HR 0.60 [0.53-0.69]; p < 0.001). SGLT2i lowered serious adverse events (RR 0.92 [0.89-0.95]; p < 0.001) and slowed renal function decline (MD 1.86 [1.15-2.58] mL/min/1.73 m² per year; p < 0.001). An increase was observed in genital (RR 3.07 [2.03-4.64]; p < 0.001) and urinary tract infections (RR 1.19 [1.03-1.38]; p = 0.02). CONCLUSIONS: In older patients with HF, SGLT2i was associated with lower mortality and HF hospitalizations and with a slower renal decline, while largely maintaining a favorable safety profile. These findings support the consideration of SGLT2i as an important therapeutic option for older adults with HF.

doi.org/10.1016/j.archger.2026.106138PubMed 41544527Interventions