Effects of SGLT2 inhibitors on cognitive impairment in elderly inpatients with heart failure with reduced ejection fraction: a prospective cohort study

Heart failure with reduced ejection fraction (HFrEF) and cognitive impairment are significant challenges faced by global healthcare systems. Clinical studies on the impact of drugs for HFrEF on cognitive impairment are very limited. We aimed to assess the effects of regular use of Sodium-Glucose cotransporter 2 inhibitor (SGLT2i) on cognitive impairment in elderly inpatients with HFrEF. A single center prospective cohort was conducted from October 2022 to October 2023. Inpatients ≥ 65 years old with HFrEF were evaluated. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE), and patients with MMSE score < 27 were included in the study and followed up for 6 months. We divided the population into the groups of regular SGLT2i users (R-SGLT2i) and Non-regular SGLT2i users (Non-R-SGLT2i). A multivariate logistic regression model was used to determine the relationship between regular use of SGLT2i and MMSE score. A total of 113 elderly hospitalized HFrEF patients with cognitive impairment were completed the study, and 54 (47.8%) patients were in R-SGLT2i, and 67.9% were male. The baseline MMSE score for the Non-R-SGLT2i and R-SGLT2i were 20.03 ± 1.50 and 20.19 ± 1.92 (P = 0.640). After 6 months of follow-up and reevaluation, the MMSE score of the Non-R-SGLT2i and R-SGLT2i were 19.78 ± 1.99 and 22.28 ± 1.76 (P < 0.001). After adjusting for age, education, left ventricular ejection fraction and type 2 diabetes, the regular use of SGLT2i was associated with higher MMSE score [OR = 3.22, 95% CI (1.37–7.55), P = 0.007]. This study shows that regular use of SGLT2i have an improving effect on cognitive impairment in elderly HFrEF patients. ChiCTR2200066070; date of registration: 11/23/2022.