Description
Objectives: To assess the 1-year risk of all-cause hospitalization or mortality associated with initiation of sodium glucose cotransporter-2 inhibitors (SGLT2i) compared with renin angiotensin system inhibitors (RASi) among Medicare beneficiaries with heart failure (HF) and Alzheimers disease and related dementias (ADRD). Methods: This cohort study used 5% 2012-2020 Medicare fee-for-service claims data to identify beneficiaries with HF and ADRD who newly initiated SGLT2i or RASi between January 1, 2013, and December 31, 2019. Baseline demographics, comorbidities, and medication use were included as covariates. Propensity score matching and standardized differences were used to assess covariate balance between the two treatment groups. The primary outcome was a composite of all-cause hospitalization or mortality within 1 year of treatment initiation. Beneficiaries were censored during follow-up upon disenrollment from Medicare Parts A, B or D, switch to Medicare Advantage, index treatment (SGLT2i or RASi) discontinuation or switching, or end of 1-year follow-up, whichever occurred first. Kaplan Meier curves and Cox hazard models were used to compare the outcomes of interest (1-year all-cause hospitalization, 1-year mortality, and composite outcome) between the treatment groups. Result: Among eligible beneficiaries, 283 SGLT2i users were matched to 543 RASi users with balanced baseline characteristics. Kaplan Meier analyses demonstrated a significantly lower 1-year all-cause hospitalization or mortality risk among SGLT2i users compared with RASi users (p=0.0082). When individual outcome was examined, SGLT2i users showed a significantly lower risk of hospitalization (p=0.013), whereas no significant difference in all-cause mortality was observed (p=0.37). In multivariable Cox regression models, SGLT2i use ([Hazard Ratio (HR): 0.70, 95% CI: 0.57-0.86] was associated with lower risk of 1-year risk of all-cause hospitalization or mortality. Conclusion: In patients with HF and ADRD, SGLT2i use was associated with lower risk of the 1-year composite of hospitalization or mortality, compared with RASi, highlighting potential benefit in this high-risk group.
Publication Info
2026.