Heart failure & cardiomyopathiesSecondary analysis
Atrial Fibrillation and Semaglutide Effects in Obesity-Related Heart Failure With Preserved Ejection Fraction
- Secondary analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials
- pooled data
- subgroup analysis by atrial fibrillation (AF) history
Authors' conclusion
The magnitude of semaglutide-mediated improvements in HF-related symptoms and physical limitations was more pronounced in those with AF vs without AF at baseline.
Study context
- Population
- Obesity-related heart failure with preserved ejection fraction (HFpEF) (LVEF ≥45%, BMI ≥30 kg/m², KCCQ-CSS <90 points), with or without history of AF518 with AF, 627 without · with 518 · or without 627
- Participants
- 1,145 participants
- Comparison
- Semaglutide 2.4 mg once weekly vs placebo, by history of AF
- Primary endpoint
- Dual primary: change in KCCQ-CSS and percent change in body weight, by history of AF
- Follow-up
- 52 weeks
Primary result
As reported in the abstract
Change in KCCQ-CSS, semaglutide vs placebo, by AF history
Semaglutide vs PlaceboDifference, points (95% CI)
with AF
11.5(8.3–14.8)
without AF
4.3(1.3–7.2)
Secondary outcomes
| Outcome | win ratio (95% CI) | |
|---|---|---|
| Hierarchical composite endpoint, by AF history — Semaglutide vs Placebo · with AF | 2.25 (1.79–2.83) | |
| Hierarchical composite endpoint, by AF history — Semaglutide vs Placebo · without AF | 1.30 (1.06–1.59) | |
| 0.20.5125Win ratio (log scale) |
- Hierarchical composite endpoint, by AF history: P interaction < 0.001
≥5-, ≥10-, ≥15- and ≥20-point KCCQ-CSS improvement, by AF history
- Higher proportions with semaglutide vs placebo in those with (vs without) AF
- all P interaction values <0.05
CRP and NT-proBNP, by AF history
- Semaglutide consistently reduced CRP and NT-proBNP regardless of AF status (P interaction not significant)
Safety
Serious adverse events and serious cardiac disorders
- Fewer with semaglutide vs placebo irrespective of AF history
Original publication
Atrial Fibrillation and Semaglutide Effects in Obesity-Related Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. Published 30 August 2024. doi:10.1016/j.jacc.2024.08.023
Summarised from the published abstract; every number is checked against it