Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review

Aim: This study aimed at summarizing the available literature on fall risk associated with diuretic and SGLT2i use in older heart failure patients, including the underlying pathophysiology, and to assist clinicians in safe (de)prescribing of these drug classes. Findings: Both heart failure and diuretic or SGLT2 inhibitor use increase fall risk in older adults. Diuretics and SGLT2 inhibitors not only have various fall-related adverse effects, which partly overlap (e.g. tendency to cause hypotension), but also differ: compared to SGLT2is, diuretics display more fall risk factors (e.g. electrolyte abnormalities). The tendency to cause fall-related adverse effects may differ according to diuretic sub-class or even within sub-classes. Message: Decisions to continue or deprescribe diuretics or SGLT2is in fall-prone older HF patients are generally highly complex, but detailed insight into fall-related side effect profiles of these drug classes, and practical clinical decision tools and resources, assist prescribers in rational and personalized (de)prescribing.