Heart failure & cardiomyopathies
Glucagon-like peptide-1 receptor agonists in patients with heart failure with reduced ejection fraction
Authors' conclusion
In this real-world cohort, GLP-1RA therapy in HFrEF was associated with reduced mortality and ADHF without an increase in arrhythmic events. Prospective randomized trials are needed to validate these findings.
Study context
- Population
- Adult patients with heart failure with reduced ejection fraction (HFrEF) (LVEF ≤40%) between 2021 and 2024met inclusion criteria, after propensity score matching (PSM) 2550 analysed · GLP-1RA (matched) 1,275 · GLP-1RA-naïve (matched) 1,275
- Participants
- 127,021 patients
- Exposure
- Patients receiving semaglutide, tirzepatide, or liraglutide were compared with GLP-1RA-naïve patients
- GLP-1RAn = 1,275
- GLP-1RA-naïven = 1,275reference
- Outcome
- All-cause mortality and ADHF hospitalizations
- Follow-up
- 1-year
Methodological detailspropensity score matching (1:1; caliper 0.1)
- Propensity score matching (1:1; caliper 0.1)
Main finding
As reported in the abstract
All-cause mortality and ADHF hospitalizations
GLP-1RA
- All-cause mortality
- 7.1%
- Acute decompensated HF (ADHF)
- 27.7%
GLP-1RA-naïve
- All-cause mortality
- 10.2%
- ADHF
- 32.8%
All-cause mortality
GLP-1RA7.1%
GLP-1RA-naïve10.2%
Acute decompensated HF (ADHF)
GLP-1RA27.7%
GLP-1RA-naïve32.8%
GLP-1RA vs GLP-1RA-naïveEstimate (95% CI)P value
All-cause mortality
OR 0.68(0.51–0.90)
P = 0.006All-cause mortality, time-to-event analysis
matched hazard ratio 0.54(0.41–0.7)
P < 0.0001ADHF
OR 0.79(0.66–0.93)
P = 0.005Observational data: associations, not effects.
Secondary outcomes
New onset acute coronary syndrome (ACS), stroke/TIA, atrial fibrillation (AF)/flutter, and ventricular tachycardia (VT)/ventricular fibrillation (VF) events
- Similar in both groups
- Secondary outcomes
Original publication
Glucagon-like peptide-1 receptor agonists in patients with heart failure with reduced ejection fraction. ESC Heart Fail. Published 17 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it