Impact of GLP-1/GIP Receptor Agonists on HF-Related Hospitalizations
Investigators: Haley Jones, PharmD; Erika Schoenborn, PharmD, BCCP, CPP; Kacy Whyte, PharmD, BCPS, BCCP
Practice Site: ECU Health Medical Center, Greenville, NC
Email: [email protected]Purpose: Despite advances in guideline directed medical therapy (GDMT), many patients with heart failure (HF) experience persistent symptoms and recurrent hospitalizations. The intersection of HF and metabolic disease is of particular clinical importance, as type 2 diabetes mellitus (T2DM) and obesity are common comorbidities across the HF spectrum and are associated with worse clinical outcomes. Glucagon-like peptide receptor agonists (GLP-1 RAs) are an established treatment for T2DM and have recently gained prominence for their benefits in weight reduction and cardiovascular risk reduction. GLP-1 RAs reduce major cardiovascular events in patients with HFpEF, but conflicting evidence exists on the safety and efficacy in HFrEF. Further investigation is warranted to clarify their role in HF management. The purpose of this study was to assess the association between use of GLP-1 RAs and rate of HF-related hospitalizations for patients with HF.
Methods: This retrospective cohort study included adult patients hospitalized with HF between January 1, 2024, and December 31, 2024. Patients were stratified by LVEF and by receipt of GLP-1 RA therapy. The primary endpoint was the rate of 30-day HF-related readmissions among patients receiving GLP-1 RA compared to those not receiving these medications. Secondary endpoints included 90-day HF-related readmission rates, time to first HF-related hospitalization, change in body weight during the study period, all-cause mortality, and administration of IV diuretics within 90 days. Patients were identified using SlicerDicer based on HF-hospitalizations within the study period, with outpatient prescriptions for a GLP-1 RA (tirzepatide or semaglutide) used to define the treatment group. Data were analyzed using descriptive statistics, Chi-Square, and Mann-Whitney U tests, as appropriate.
Results: A total of 407 patients were screened for inclusion, with 106 patients included in each group. The median age was 69 yrs (IQR 60-77), 52% female, and 53.3% black patients. A total of 22 patients (20.7%) in the treatment group experienced 30-day HF-related readmission, compared with 19 patients (17.9%) in the control group (p = 0.60). Among patients with HFrEF, 30-day readmission occurred in 11 patients (22.9%) in the treatment group and 6 patients (15.8%) in the control group (p = 0.41). At 90 days, HF-related readmission occurred in 38 patients (35.8%) in the treatment group and 41 patients (38.7%) in the control group (p = 0.63). Median time to first HF-related hospitalization was 25 days (IQR 12-64) in the treatment group and 38 days (IQR 15-62) in the control group (p = 0.55). All-cause mortality occurred in 8 patients in the treatment group and 9 patients in the control group (p = 0.80).
In the HFrEF subgroup, increased diuretic doses at 30 days were observed in 27 patients (60.0%) in the treatment group compared with 15 patients (40.5%) in the control group (p = 0.20), and at 90 days in 24 patients (58.5%) versus 14 patients (41.2%), respectively (p = 0.203). In the HFpEF/HFimpEF group, increased diuretic doses at 30 days occurred in 16 patients (37.2%) in the treatment group and 20 patients (41.7%) in the control group (p = 0.91), and at 90 days in 15 patients (37.5%) and 20 patients (46.5%), respectively (p = 0.62).
Conclusions: In this retrospective analysis of patients with HF, GLP-1 RA therapy was not associated with differences in 30-day or 90-day HF-related readmission rates compared with no GLP-1 RA use. Although not statistically significant, a higher proportion of patients with HFrEF receiving GLP-1 RAs required increased diuretic dosing at 30 and 90 days, a pattern not observed in patients with HFpEF/HFimpEF. These findings suggest potential differences in clinical response by ejection fraction and highlight the need for further investigation into the safety and role of GLP-1RA in patients with HFrEF.
