Initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) during hospitalization is recommended for patients with heart failure, yet real-world uptake remains inconsistent. A single-center retrospective observational analysis of a prospective registry published in Clinical Drug Investigation assessed the initiation of SGLT2i among patients hospitalized for heart failure (HF).

The study included 781 consecutive patients hospitalized for HF between 2021 and 2024. After applying eligibility criteria and excluding incomplete data, 467 patients were included in the final analysis (median age 81 years [74-87]; 50.3% male).

The in-hospital initiation rate of SGLT2i was 37.3% (174/467), with treatment discontinuation after initiation occurring at 8.6% (15/174). Multivariable logistic regression identified older age, absence of diabetes, impaired renal function, higher left ventricular ejection fraction (LVEF), malnutrition, impaired mobility, and cognitive dysfunction as independent factors associated with non-initiation. 

Among 346 patients with follow-up data, the 1-year composite endpoint of all-cause mortality or HF rehospitalization occurred more frequently in the non-initiation group than in the initiation group (37.5% vs 21.3%; log-rank p=0.001). Non-prescription of SGLT2i at discharge remained independently associated with the composite outcome of all-cause mortality or HF rehospitalization (HR 1.70; 95% CI 1.07-2.69; p=0.02).

Both clinical factors and aging-related characteristics were independently associated with non-initiation of SGLT2i in hospitalized HF patients. Absence of SGLT2i therapy at discharge was associated with higher risk of adverse outcomes at one year.