Abstract 4144048: Propensity Score-Matched Analysis of GLP-1 Agonists' Impact on Clinical Cardiovascular Outcomes in Patients with Concurrent Heart Failure and Atrial Fibrillation

Background: Heart failure (HF) and paroxysmal atrial fibrillation (AF) are major causes of morbidity and mortality, each exacerbating the other and leading to poorer outcomes. Glucagon-like peptide-1 agonists (GLP-1a), primarily used for glycemic control in type 2 diabetes, may offer cardiovascular benefits in patients with concurrent HF and paroxysmal AF. Objective: This study aims to evaluate the impact of GLP-1a on clinical outcomes in patients with concurrent HF and paroxysmal AF. Methods: This retrospective study utilized data from 51,446 HFrEF patients across 91 global healthcare organizations between January 2014 and August 2023. Propensity score matching (PSM) analysis was used to compare cardiovascular outcomes such as all-cause mortality, the need for new antiarrhythmic medication, cardioversion, AF ablation, incidence of acute myocardial infarction (AMI), and cardiac arrest, between those treated with GLP-1a and those who were not. Results: Our analysis revealed that the GLP-1a group had significantly lower odds of requiring cardioversion (3.1% vs 5.0%, OR = 0.67, 95% CI: 0.45–0.99, p=0.041), AF ablation (1.7% vs 3.7%, OR = 0.51, 95% CI: 0.27–0.98, p=0.038), new antiarrhythmic drugs (12.0% vs 13.9%, OR = 0.81, 95% CI: 0.66–0.99, p=0.036), experiencing AMI (OR: 0.70, 95% CI: 0.50–0.98, p=0.035), experiencing cardiac arrest (OR: 0.54, 95% CI: 0.37–0.80, p=0.002), and all-cause mortality (OR: 0.59, 95% CI: 0.51–0.68, p<0.001) compared to the non-GLP-1a group. There were no significant differences between the groups in the need for pacemaker/ICD implantation, development of persistent or long-standing persistent AF, or the risk of ventricular fibrillation or flutter. Furthermore, Kaplan-Meier analysis showed a higher 5-year incidence-free probability of cardiac arrest (94.9% vs 90.5%), AMI (90.2% vs 87.2%, p=0.017), and a higher 5-year survival probability (62.3% vs 51.2%, p<0.001) in the GLP-1a group compared to the non-GLP-1a group Conclusion: GLP-1a treatment is associated with improved clinical cardiovascular outcomes, including reduced need for new antiarrhythmic drugs, AF ablation, cardioversion, lower incidence of AMI, cardiac arrest, and all-cause mortality in patients with concurrent HF and paroxysmal AF. These findings suggest potential therapeutic benefits of GLP-1a. Additional studies are recommended to validate these findings and investigate the underlying mechanisms.