SGLT2 Inhibitors Best ARNIs in Frail, Older Adults With HFpEF

A new real-world study (Medscape, Oct 2025) found that in adults ≥ 65 with HFpEF and frailty, starting an SGLT2 inhibitor led to better survival and fewer hospital readmissions than starting an ARNI.

Key Findings:

• 24% ↓ mortality at 90 days

• 19% ↓ mortality at 6 months

• 16% ↓ mortality at 1 year

• Fewer HF-related readmissions across all timepoints

Note: The study was observational, but results reinforce current guidelines favoring SGLT2 inhibitors as first-line therapy for HFpEF.

Takeaway:For frail, older adults with HFpEF, SGLT2 inhibitors may offer a safer, more effective first step than ARNIs—while still requiring individualized care decisions.

https://www.medscape.com/viewarticle/sglt2-inhibitors-best-arnis-frail-older-adults-hfpef-2025a1000shi?ecd=WNL_OMS_all_en_etid7828360_251027_1&uac=280853DV&impID=7828360