BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited. This observational study aimed to assess the real-world efficacy and safety of SGLT2i in elderly patients with HF. METHODS: This prospective multicenter study included 496 patients hospitalized for acute heart failure across 3 geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.2. Participants were divided into 2 groups: the SGLT2i group (n=260) receiving SGLT2i (empagliflozin or dapagliflozin) alongside standard HF treatment, and the Control group (n=236) receiving only standard HF treatment. The primary outcomes were all-cause mortality, HF rehospitalizations, and adverse events over 1 year. RESULTS: SGLT2i use was associated with lower risks of all-cause mortality (hazard ratio, 0.67 [95% CI, 0.46–0.98]; P =0.031), HF rehospitalization (hazard ratio, 0.64 [95% CI, 0.42–0.97]; P =0.037), and the composite outcome (hazard ratio, 0.60 [95% CI, 0.44–0.82]; P =0.001) at 1 year, after multivariable adjustment. No significant interaction was observed between left ventricular ejection fraction status and SGLT2i use ( P for interaction=0.12). Although urinary and genital infections were more frequently reported in the SGLT2i group, treatment discontinuation remained low (2.7%). CONCLUSIONS: In this elderly population with high comorbidity, SGLT2i therapy was associated with substantial reductions in mortality and HF rehospitalization, and showed good tolerability and an acceptable safety profile.

Background/Objectives: Patients with heart failure (HF) are vulnerable to vaccine-preventable infections, yet vaccination data remain limited. We assessed perceived vaccination knowledge, attitudes, self-reported vaccine receipt, and variation by age, sex, region, and delivery pathway among digitally connected patients with HF enrolled in a nationwide telemonitoring program. Methods: This cross-sectional electronic survey was conducted from 5 to 28 November 2025, during the ongoing 2025–2026 influenza and COVID-19 vaccination campaigns, among app-connected Satelia^® Cardio participants across France. Of 4856 invited app-connected patients, 1100 completed the questionnaire (response rate: 22.7%). Uptake of seasonal influenza and COVID-19 booster vaccination for the 2025–2026 season and lifetime receipt of pneumococcal, tetanus–diphtheria–pertussis–poliomyelitis (Tdap-polio), and herpes zoster vaccines were analyzed using Wilson 95% confidence intervals (CIs), age-adjusted logistic regression, and regional models adjusted for age and sex. Results: Respondents had a mean age of 71.5 years (SD: 12.6), and 718 (65.3%) were men. Overall, 87.5% considered vaccination useful, 96.0% knew where to be vaccinated, and 55.1% wanted telemonitoring-based reminders. Current-season reported vaccination was 62.2% for influenza and 31.4% for the COVID-19 booster, whereas lifetime self-reported receipt was 38.5% for Tdap-polio, 34.5% for pneumococcal vaccination, and 11.5% for herpes zoster. Influenza and COVID-19 uptake increased with age, whereas pneumococcal uptake peaked at 65–74 years. Pneumococcal receipt was higher in women than men (42.2% vs. 30.4%; age-adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.29–2.17; p < 0.001). Community pharmacies delivered most influenza and COVID-19 vaccinations. Conclusions: Vaccination attitudes were favorable, while current-season vaccination and lifetime-reported vaccine receipt showed distinct patterns across age groups. These descriptive findings identify potential target groups for future telemonitoring-based preventive interventions, whose effectiveness requires prospective evaluation.