Presentation (CTI)

OBJECTIVES: To evaluate healthcare resource utilization (HCRU), cost of care, and clinical outcomes among very elderly patients with heart failure (HF) who initiated empagliflozin compared with standard-of-care (SOC) therapy in routine clinical practice.
METHODS: We conducted a retrospective cohort study using a large, de-identified U.S. electronic health record dataset linked to claims data (2022-present). Patients aged ≥75 years with a history of HF who initiated empagliflozin were compared with contemporaneous patients receiving SOC therapy. Outcomes over 12 months included inpatient days, emergency department (ED) visits, outpatient visits, total paid costs, and change in left ventricular ejection fraction (LVEF). Propensity score matching was used to balance demographics, comorbidities, baseline LVEF, and healthcare utilization. Incidence rate ratios (IRRs) were estimated for utilization outcomes, and mean differences were calculated for cost and LVEF.
RESULTS: The unmatched cohort included 16,693 empagliflozin users and 21,979 SOC patients, with a mean age of approximately 80 years. After propensity score matching, empagliflozin use was not associated with significant differences in inpatient days (IRR 0.96; 95% CI 0.88-1.03), ED visits (IRR 0.95; 95% CI 0.88-1.02), or outpatient visits (IRR 0.95; 95% CI 0.88-1.02). Mean total paid costs were numerically lower in the empagliflozin group but did not reach statistical significance (−$1,000; 95% CI −$2,100 to $59). Changes in LVEF were also not significantly different between groups.
CONCLUSIONS: In very elderly patients with HF, initiation of empagliflozin was not associated with statistically significant reductions in HCRU, cost of care, or improvement in LVEF compared with SOC over one year. These findings highlight potential differences between clinical trial efficacy and real-world effectiveness in highly comorbid, elderly populations.