Treatment With GLP-1RAs Not Linked to Improved Prognosis in Heart Failure

In patients with a history of heart failure (HF) and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs), is not associated with a reduction in HF hospital readmissions, according to the results of a systematic review and meta-analysis published in the journal Clinical Therapeutics.

Researchers searched databases from inception through July 2022. The aim was to identify published randomized controlled trials (RCTs) that evaluated treatment with GLP-1RAs in individuals both with and without diabetes. Study outcomes included HF hospitalization, cardiac function, and measures of structure.

A total of 22 RCTs that comprised 61,412 patients were included in the meta-analysis. Results of the analysis showed that, compared with placebo groups, treatment with GLP-1RAs in patients with a history of HF was not associated with a significant reduction in hospitalization for HF (hazard ratio, 1.07; 95% CI, 0.91-1.25; P =.422).

After the administration of GLP-1RAs, the following all increased significantly:

• Six-minute walking test distances (weighted mean difference [WMD], 19.08 m; 95% CI, 4.81-33.36; P =.01)
• E-wave (standardized mean difference, -0.40; 95% CI, -0.60 to
  -0.20; P <.001)
• Early diastolic to late diastolic velocities ratio (WMD, -0.10; 95% CI,
  -0.18 to -0.02; P =.01)
• Mitral inflow E velocity to tissue Doppler e′ ratio (WMD, -0.97; 95% CI, -1.54 to -0.41; P <.001)
• E-wave deceleration time (WMD, -9.96 milliseconds; 95% CI, -18.52 to -1.41; P =.02)

Treatment with GLP-1RAs, however, did not significantly impact NT-proBNP levels (WMD, -20.02 pg/mL; 95% CI, -53.12 to 13.08; P =.24), Minnesota Living with Heart Failure Questionnaire quality-of-life scores (WMD, -1.08; 95% CI, -3.99 to 1.84; P =.47), and left ventricular ejection fractions (WMD, -0.37%; 95% CI, -1.19 to 0.46; P =.38).

Some limitations of the study include that in the meta-analysis, other primary drug treatments taken by patients that might influence their cardiac function, such as spironolactone, are not evaluated. Additionally, because the ventricular diastolic function is improved, when exploring the risk for HF hospitalization among patients with a history of HF, the original RCTs did not group the participants into HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF); therefore, the effect of HFrEF and HFpEF on rates of hospitalization for HF could not be explored.

“Although no significant reduction in heart failure hospitalization was found in patients taking GLP-1RAs, the diastolic function according to echocardiography was significantly improved by GLP-1RAs,” the study authors wrote. “An RCT of patients with diabetes and HFpEF is worthwhile to explore the effect of GLP-1RAs on cardiac function and prognosis of heart failure.”