Glucagon-like peptide-1 receptor agonists use and associations with outcomes in heart failure and type 2 diabetes: data from the Swedish Heart Failure and Swedish National Diabetes Registries

Abstract

Aims: To assess the use and associations with outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in a real-world population with heart failure (HF) and type 2 diabetes mellitus (T2DM).

Methods and results: The Swedish HF Registry was linked with the National Diabetes Registry and other national registries. Independent predictors of GLP-1 RA use were assessed by multivariable logistic regressions and associations with outcomes were assessed by Cox regressions in a 1:1 propensity score-matched cohort. Of 8188 patients enrolled in 2017-21, 9% received a GLP-1 RA. Independent predictors of GLP-1 RA use were age <75 years, worse glycaemic control, impaired renal function, obesity, and reduced ejection fraction (EF). GLP-1 RA use was not significantly associated with a composite of HF hospitalization (HHF) or cardiovascular (CV) death regardless of EF, but was associated with a lower risk of major adverse CV events (CV death, non-fatal stroke/transient ischaemic attack, or myocardial infarction), and CV and all-cause death. In patients with body mass index ≥30 kg/m2, GLP-1 RA use was also associated with a lower risk of HHF/CV death and HHF alone.

Conclusions: In patients with HF and T2DM, GLP-1 RA use was independently associated with more severe T2DM, reduced EF, and obesity and was not associated with a higher risk of HHF/CV death but with longer survival and less major CV adverse events. An association with lower HHF/CV death and HHF was observed in obese patients. Our findings provide new insights into GLP-1 RA use and its safety in HF and T2DM.

Keywords: Glucagon-like peptide-1 receptor agonists; Heart failure; Registry; Safety; SwedeHF; Type 2 diabetes.

Graphical Abstract

Figure 1

Independent predictors of GLP-1 RA use. Abbreviations as in Table 1.

Figure 2

Outcome analysis. PS, propensity score; HR, hazard ratio; CI, confidence interval; HF, heart failure; CV, cardiovascular; MACE, major adverse cardiovascular events; TIA, transient ischaemic attack; GLP-1 RA, glucagon-like peptide-1 receptor agonists.

Figure 3

Subgroup analysis for the primary composite outcome performed in the propensity score-matched cohort. Abbreviations as in Table 1.