Hemodynamic Changes in response to GLP-1 RA treatment in ICD and CRT patients: Insights from HeartLogic Sensor Data

Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as effective antihyperglycemic agents with demonstrated cardiovascular benefits. However, the specific hemodynamic effects of GLP-1 RAs as assessed by HeartLogic Sensor Data remain unknown. The HeartLogic algorithm, which integrates multiple sensor-derived parameters, offers valuable insights into hemodynamic changes, providing a novel opportunity to assess the mechanistic impact of GLP-1 RAs in high-risk populations. This study is the first to leverage intracardiac monitoring to evaluate the hemodynamic impact of GLP-1 RAs in a real-world cohort. Purpose This study evaluates GLP-1 RA hemodynamic effects via HeartLogic trends. Methods This retrospective analysis included a nationwide cohort of adult patients implanted with a HeartLogic-compatible monitoring device. Patients were identified via Danish health registries by device type and clinical characteristics. HeartLogic data and medication records were extracted for analysis. Patients were followed from 2017–2024 and categorized as: (1) GLP-1 RA initiators, (2) continuous GLP-1 RA users, (3) non-users. HeartLogic sensor data were aligned with continuous GLP-1 RA users and non-users at a randomly selected baseline, with analyses spanning 90 days before and 60 days after initiation. Associations between GLP-1 RA use and hemodynamic changes were analyzed using time-dependent Cox proportional hazard models. Sensor parameter differences were assessed via one-way ANOVA with Tukey’s post hoc analysis. Results A total of 1799 patients were included, with 38 receiving GLP-1 RA continuously and 42 initiating treatment during the observation period. The mean age was 58.6 ± 14.0 years, 75.6% were male, and 469 (25%) had a CRT-D device. The total observation time was 5823 patient-years, including 308 patient-years in GLP-1 RA treatment. GLP-1 RA initiators were younger (53.8 ± 11.2 years), had a higher BMI (36.6 kg/m²), and a greater symptom burden (NYHA score). Hospital admissions and mortality rates were comparable across groups. With GLP-1 RA initiation we observed a significant HeartLogic score increase (mean ∆4.82, p = 0.0347) relative to non-users and continuous users. This was driven by an increase in left ventricular filling pressure (S3), while contractility (S1) remained stable. No significant changes were observed in thoracic impedance or heart rate, indicating volume redistribution rather than overt congestion. Additionally, atrial fibrillation burden increased after GLP-1 RA initiation. ApneaScan scores improved significantly (∆−3 to −6, p = 0.02) potentially due to weight loss. Conclusion GLP-1 RAs was associated with increased HeartLogic score due to elevated filling pressure, requiring caution in heart failure patients. Future research should assess dose-dependent effects and long-term outcomes.