GLP-1 Receptor Agonists in Heart Failure: Insights From a Cardiometabolic Center of Excellence

Background: Data regarding the use of GLP-1 receptor agonists (GLP-1RA) in patients with established heart failure (HF) remain limited. Methods: We included patients with established HF treated at Cardiometabolic Center (CMC) between January 2019 and December 2020 who had at least two visits and received GLP-1RA. We compared change in outcomes of interest between baseline and last CMC visit. Results: Among 151 HF patients treated with GLP-1RA, 88 had HF with reduced ejection fraction (HFrEF) and 63 had preserved ejection fraction (HFpEF); 92% had type 2 diabetes (T2D), the rest had prediabetes, and 27% were on SGLT-2i at baseline. After a median follow-up of 6.6 (3.7-11) months, 92% of patients remained on GLP-1RA, (64% were also receiving SGLT-2i at last follow up). The median time on GLP-1RA therapy was 5.4 (3-9.7) months with HFrEF, and 6.1 (3.4-11.8) months with HFpEF. We observed reductions in median total daily insulin doses in both HFrEF and HFpEF patients (from 60 to 39 units, and 53 to 31 units, respectively, p<0.001 for both), mean HbA1c (7.7% to 6.9%, p<0.001 and 7.2% to 6.8%, p=0.002 respectively), and mean percent body weight (-6.2% and -7.9% respectively, p<0.001 for both) ( Figure ). Additionally, lower rates of hospitalizations or urgent visits for HF were seen in those with HFrEF [13.6% vs. 34.1% (p<0.001)], and HFpEF [from 15.9% vs. 33.3% (p=0.01)] during follow-up time compared with an equal duration prior to care at CMC (6.3 months with HFrEF, and 6.9 months with HFpEF). GLP-1RA therapy was generally well-tolerated with side effects in 31% of patients (mainly gastrointestinal complaints), but only 6% required drug discontinuation. Three patients stopped GLP-1RA due to cost. Conclusion: GLP-1RA therapy (in combination with SGLT-2i in most patients) was well-tolerated in both HFrEF and HFpEF, and was associated with significant reductions in insulin dose, HbA1c, body weight, and lower risk of hospitalizations or urgent visits for HF after initiation of therapy.