Heart rate increases in liraglutide treated chronic heart failure patients: association with clinical parameters and adverse events

Rasmus Stilling Tougaard; Anders Jorsal; Lise Tarnow; Nils Henrik Hansson; Caroline Kistorp; Morten Schou; Roni Nielsen; Allan Flyvbjerg; Lars Videbæk; Henning Mølgaard; Jens Cosedis Nielsen; Henrik Wiggers

doi:10.1080/14017431.2020.1751873

April 15, 2020Scandinavian Cardiovascular JournalOpen Access

Heart rate increases in liraglutide treated chronic heart failure patients: association with clinical parameters and adverse events

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Why the study?

Liraglutide increases heart rate and possibly the risk of cardiovascular events in chronic heart failure patients, but its association with clinical parameters and events is unclear.

Does liraglutide increase heart rate and adverse events in chronic heart failure patients with LVEF ≤45%?

Structured PICO

Does liraglutide increase heart rate and adverse events in chronic heart failure patients with LVEF ≤45%?

P

Population

241 chronic heart failure (CHF) patients with a left ventricular ejection fraction ≤45%

I

Intervention

Liraglutide 1.8 mg daily for 24 weeks

C

Comparator

Placebo

O

Outcome

Heart rate changes and arrhythmiassurrogate

Liraglutide significantly increases heart rate in heart failure patients with sinus rhythm, though this increase does not appear to be associated with short-term serious cardiac adverse events.

Implication

HR increases with liraglutide in CHF were unlinked to events or parameters; leaves open long-term safety implications.

Abstract

Background. Liraglutide, a glucagon-like peptide-1 agonist, is used for treatment of type 2 diabetes and has beneficial cardiovascular properties. However, treatment increases heart rate (HR) and possibly the risk of cardiovascular events in chronic heart failure (CHF) patients. We investigated potential associations between HR changes and clinical, laboratory and echocardiographic parameters and clinical events in liraglutide treated CHF patients. Methods. This was a sub-study of the LIVE study. CHF patients (N = 241) with a left ventricular ejection fraction ≤45% were randomised to 1.8 mg liraglutide daily or placebo for 24 weeks. Electrocardiograms (N = 117) and readouts from cardiac implanted electronic devices (N = 20) were analysed for HR and arrhythmias. Results. In patients with sinus rhythm (SR), liraglutide increased HR by 8 ± 9 bpm (pulse measurements), 9 ± 9 bpm (ECG measurements) and 9 ± 6 bpm (device readouts) versus placebo (all p<.005). Increases in HR correlated with liraglutide dose (p=.01). HR remained unchanged in patients without SR. Serious cardiac adverse events were not associated with HR changes. Conclusions. During 6 months of treatment, HR increased substantially in CHF patients with SR treated with liraglutide but was not associated with adverse events. The long-term clinical significance of increased HR in liraglutide treated CHF patients needs to be determined.