Glucagon-Like Peptide 1 Receptor Agonist Is Associated With Improved Survival in Overweight Heart Failure Patients

Background: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have shown improved symptomatic relieving and functional capacity in patients with heart failure (HF) with preserved ejection fraction and obesity.

Objectives: The purpose of this study was to evaluate the effect of GLP-1RA on outcome in patients with HF.

Methods: A retrospective analysis was performed based on the Swedish HF Registry since 2007 among patients with a body mass index (BMI) >25 kg/m to assess whether GLP-1RA treatment was associated with reduced mortality in patients with HF.

Results: In the overall cohort, 34,247 patients were not treated with GLP-1RA, and 808 patients were. In patients treated with GLP-1RA, 96.3% had diabetes mellitus. Treatment with GLP-1RA showed a statistically significant association with reduced all-cause (adjusted HR [aHR]: 0.75 [95% CI: 0.60-0.94]; P = 0.013) and cardiovascular (CV) mortality (aHR: 0.52 [95% CI: 0.35-0.77]; P = 0.0010) compared with those not receiving GLP-1RA within 2 years after index registration. In a 1:1 propensity score matched cohort, there was no significant association between GLP-1RA and all-cause mortality (aHR: 0.79 [95% CI: 0.59-1.06]; P = 0.11), but there was with CV mortality (aHR: 0.53 [95% CI: 0.32-0.87]; P = 0.012). GLP-1RA-associated risk reduction in CV death was more pronounced in patients with a BMI >30 kg/m and appears to be greater in individuals with an ejection fraction ≤40% compared with >40%.

Conclusions: This nationwide real-world study shows that patients with HF who received GLP-1RA have a significant reduction in CV mortality, which is particularly pronounced in overweight and obese patients with reduced ejection fraction.