SGLT2 inhibitor prescription at discharge in very old adults with heart failure irrespective of diabetes status

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended across the heart failure (HF) spectrum, irrespective of diabetes status. However, prescribing patterns in very old adults with multimorbidity, renal dysfunction, and geriatric vulnerability remain insufficiently characterised. METHODS: We conducted a single-centre retrospective cross-sectional study in a specialised acute cardiogeriatric unit between January 1, 2025, and February 13, 2026. Consecutive hospitalisations with confirmed HF and documented SGLT2i discharge status were included. The primary outcome was absence of SGLT2i at discharge. Multivariable logistic regression identified factors independently associated with non-prescription. RESULTS: Among 1235 hospitalisations, median age was 88.6 years [IQR 82-92], 54.5% were women, and 32.7% had diabetes. SGLT2i were prescribed in 1016 hospitalisations (82.3%) and absent in 219 (17.7%). Prescription did not differ by diabetes status (80.4% vs 83.2%, p = 0.276) or across HbA1c tertiles. In the prespecified primary model, non-prescription was associated with CKD stage 4 (aOR 2.79 [95% CI 1.97-3.96]), CKD stage 5 (aOR 20.29 [9.67-42.56]), palliative orientation (aOR 1.62 [1.09-2.41]), and HFrEF versus HFpEF (aOR 1.55 [1.08-2.22]). Higher albumin and medication count were associated with lower odds of non-prescription. Diabetes, age, and Charlson Comorbidity Index were not independently associated with the primary outcome. CONCLUSION: SGLT2i prescription was frequent and similar according to diabetes status and glycaemic control. Advanced CKD and palliative-oriented care were the most consistent correlates of non-prescription. These findings describe prescribing patterns but do not establish the appropriateness of individual decisions.