Semaglutide in Heart Failure with Preserved Ejection Fraction and Obesity: The Gap Between Discussion and Use

Introduction: Semaglutide improves symptoms and physical function in heart failure with preserved ejection fraction (HFpEF) and obesity. Whether discussion of treatment is accompanied by its use in routine care is less well understood. Methods: We retrospectively assessed treatment discussion, follow-up medication records and documented reasons for non-initiation in 159 patients from a prospective registry. Available follow-up information was retained when assessment dates were incompletely transcribed. Associations with registry-recorded diabetes or prediabetes were explored using Firth logistic regression. Results: Semaglutide was discussed or offered in 148/159 patients (93.1%). Among 148 baseline nonusers with subsequent medication information, it was newly recorded in 23 (15.5%). Recorded diabetes or prediabetes was associated with this outcome (adjusted odds ratio 3.76, 95% confidence interval 1.08–19.93), but a sensitivity analysis restricting the reference group by glycated haemoglobin was inconclusive. Among 125 patients without subsequently recorded semaglutide, affordability concerns were documented in 55 (44.0%), safety concerns in 48 (38.4%), and both in 38 (30.4%). Conclusion: Frequent discussion of semaglutide coexisted with infrequent documentation of subsequent use. Financial and medication-related concerns commonly overlapped. These findings identify a gap in routine care without establishing its causal determinants or verifying treatment initiation.