What is the clinical evidence from this study?

Study design: Cohort. Population: Obesity and heart failure (n=52). Intervention: Semaglutide vs. Medical therapy alone. Primary outcome: Change in body mass index (BMI) at one year (MD 3.42, 95% CI 1.43 to 5.42, p=0.001).

October 26, 2024BMC Cardiovascular DisordersOpen Access

Impact of semaglutide on weight and functional outcomes among obese heart failure patients: a propensity scores matching analysis

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Key result

Semaglutide was associated with a significant mean BMI reduction of 2.91 kg/m² (mean difference 3.42 kg/m²) compared to medical therapy alone at one year in obese patients with heart failure.

Why the study?

Obesity is a common comorbidity in heart failure, but effective pharmacological options for weight loss are limited.

Does semaglutide reduce weight and improve functional outcomes in obese patients with heart failure?

Study Design

Type

Cohort (n=52)

Multicenter

Structured PICO

Does semaglutide reduce weight and improve functional outcomes in obese patients with heart failure?

Population

52 propensity-matched obese adults with heart failure on guideline-directed medical therapy, followed for one year.

Exposure

Semaglutide administered subcutaneously, starting at 0.25 mg per week and gradually escalated every four weeks to a maximum dose of 1.0 mg per week, added to guideline-directed medical therapy for 1 year.

Comparator

Conservative management (medical therapy alone) during the same time period, matched using propensity scores.

Outcome

Changes in body mass index (BMI), improvements in NYHA class, and changes in the 6-minute walk distance (6MWD) from baseline to the one-year follow-up.surrogate

Main Result

Mean Difference: 3.42 (95% CI 1.43–5.42)

Absolute Event Rate: -2.91% vs -0.41%

p-value: p=0.001

In a real-world cohort of obese patients with heart failure, semaglutide at a maximum dose of 1.0 mg weekly significantly reduced BMI, improved NYHA functional class, increased 6-minute walk distance, and lowered NT-proBNP levels over one year compared to medical therapy alone.

Limitations

Single-center study restricts generalizability
Small sample size of 26 matched pairs limits depth of data analysis
Retrospective design makes it susceptible to selection and information biases
Maximum semaglutide dose used was 1.0 mg, which is lower than the 2.4 mg dose approved for weight loss
One-year follow-up period may be insufficient to assess long-term effects and safety
Single-center study restricting generalizability
Small sample size of 26 matched pairs limiting depth of data analysis
Retrospective design susceptible to selection and information biases
Maximum semaglutide dose used was 1.0 mg, lower than the 2.4 mg approved for weight loss
One-year follow-up period may be insufficient to assess long-term effects, safety, and potential adverse outcomes

Implication

May support semaglutide for weight and function in obese HF; leaves open need for randomized confirmation before practice change.

Abstract

BACKGROUND & OBJECTIVES: Obesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide's impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure. METHODS: A retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control). RESULTS: Among 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions. CONCLUSIONS: Semaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction.

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Published by BMC Cardiovascular Disorders · CC BY

Cite This Study

Balata et al. (2024) conducted a cohort in Obesity and heart failure (n=52). Semaglutide vs. Medical therapy alone was evaluated on Change in body mass index (BMI) at one year (MD 3.42, 95% CI 1.43 to 5.42, p=0.001). Semaglutide was associated with a significant mean BMI reduction of 2.91 kg/m² (mean difference 3.42 kg/m²) compared to medical therapy alone at one year in obese patients with heart failure.

synapsesocial.com/papers/6a75b6be1078cf7de2b23b6f https://doi.org/10.1186/s12872-024-04275-2