A-114 | Impact of GLP-1 Receptor agonist in patients with HFpEF on SGLT inhibitors post-TAVR: A propensity-matched analysis

Background: Patients with HFpEF undergoing transcatheter aortic valve replacement (TAVR) remain at high risk for adverse cardiovascular outcomes despite guideline-directed therapy.While sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in HFpEF, the incremental benefit of adding glucagon-like peptide-1 (GLP-1) receptor agonists in this population is not well established.Methods: Using the TriNetX U.S. Collaborative Network, we conducted a retrospective cohort study of adult patients with HFpEF who underwent TAVR between 2014 and 2024 and were treated with SGLT2 inhibitors.Patients receiving combined GLP-1 receptor agonist and SGLT2 inhibitor therapy were compared with those receiving SGLT2 inhibitors alone.Propensity score matching was performed to balance baseline demographics, comorbidities, medications, and laboratory values.Clinical outcomes were assessed from 30 days to 1 year after the index event.Results: Matched cohorts: n=925 each.At 1 year, GLP-1 RA with SGLT2i use reduced all-cause mortality (5.1% vs 11.0%; HR 0.48, 95% CI 0.34-0.68;p<0.001),HF hospitalization (10.3% vs 16.4%; HR 0.62, 95% CI 0.48-0.80;p<0.001), all-cause hospitalization (28.5% vs 34.4%; HR 0.82, 95% CI 0.69-0.96;p=0.014), and 3-point MACE (17.1% vs 24.3%; HR 0.72, 95% CI 0.59-0.88;p=0.001) compared to SGLT2i alone; ischemic stroke was similar (8.3% vs 7.8%; p=0.67).Conclusions: In HFpEF patients undergoing TAVR on SGLT2 inhibitors, adding GLP-1 agonists was associated with lower 1-year mortality, HF, and all-cause hospitalizations, and MACE, supporting prospective randomized evaluation.