Abstract
BACKGROUND: Obesity is well-established risk factor of heart failure (HF); however, "obesity paradox" has been described in symptomatic HF patients. The STEP-HFpEF study suggested that once-weekly subcutaneous semaglutide might improve outcomes in patients with obesity-related HF. We explored the prevalence of obesity-related eligibility for semaglutide treatment among patients with acute decompensated heart failure (ADHF) and evaluated their prognoses. METHODS AND RESULTS: We analyzed data from 1,017 ADHF patients (median, 81 years; 44.2% female) enrolled in the CURE-HF registry. We assessed prevalence of obesity-related eligibility for semaglutide administration and examined the association between this eligibility and all-cause death over a median follow-up of 2.7 years. There were 73 patients (7.2%) who were semaglutide-eligible and they had a higher proportion of diabetes mellitus than patients who were semaglutide non-eligible (64.4% vs. 26.4%, P<0.001). Kaplan-Meier analysis indicated that semaglutide-eligible patients had a significantly lower all-cause mortality rate than non-eligible patients (log-rank P=0.005). After adjustment for demographic characteristics, there was no significant difference in mortality rate between the 2 groups (adjusted hazard ratio 0.63, 95% confidence interval (CI) 0.34-1.17, P=0.14). In the propensity score-matched cohort, we did not observe a significant difference in mortality rate (log-rank, P=0.79). CONCLUSIONS: Almost 7.2% of the ADHF patients were semaglutide-eligible. Our findings did not affirm the "obesity paradox" in semaglutide-eligible HF patients after adjusting for demographic factors.