Effects of Glucagon-Like Peptide 1 Receptor Agonist Initiation in Patients With Heart Failure With Reduced Ejection Fraction and Implantable Cardiac Devices.

BACKGROUND

Glucagon-like peptide 1 receptor agonists (GLP1RAs) may increase heart rate in patients with heart failure with reduced ejection fraction (HFrEF), which could induce deleterious effects in this population. Information retrieved from implanted cardiac devices may provide more insights into GLP1RA-associated effects on heart rate and arrhythmic events.

OBJECTIVES

This study aims to analyze the effects of GLP1RA on device-related rhythm parameters in patients with HFrEF and implanted cardiac devices.

METHODS

The authors performed a retrospective analysis of outpatients with HFrEF with implanted cardiac devices followed in cardiorenal clinics from a single-center quaternary care hospital in Canada. GLP1RA users were compared with GLP1RA nonusers with similar baseline characteristics for longitudinal changes (1-year follow-up) in heart rate, using data from electrophysiology interrogation reports. Secondary endpoints included relevant arrhythmic events, changes in body mass index (BMI), and laboratory biomarkers.

RESULTS

Among 253 patients with HFrEF and implanted cardiac devices, 53 new GLP1RA users were compared with 53 GLP1RA nonusers. The mean age was 66 ± 10 years, 81% were men, 93% had diabetes, and 36% had atrial fibrillation. The mean BMI was 31.4 kg/m2, and the mean ejection fraction was 28% ± 10%. After adjustment, GLP1RA use (vs no use) significantly increased heart rate by +7 beats/min (95% CI: 4-10 beats/min; P < 0.01). GLP1RA use (vs no use) was associated with a numeric increase in ventricular tachycardia/fibrillation events (13 vs 2; P = 0.07) and a significant increase in nonsustained ventricular events and total shock/antitachycardia pacing therapies (33 vs 3; P = 0.01).

CONCLUSIONS

In this retrospective analysis of patients with HFrEF and implanted cardiac devices, GLP1RA use was associated with significant increase in heart rate and increased number of nonsustained ventricular events and total shock/antitachycardia pacing therapies. These findings highlight the need for further evaluation of GLP1RA use in HFrEF.