Faculty Bibliography

BACKGROUND/UNASSIGNED:Guidelines recommend palliative care (PC) for patients with heart failure. However, little research has been performed assessing the effect of PC consultation in patients with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES/UNASSIGNED:The purpose of this study was to investigate the impact of PC consultation on symptom burden and health care utilization among individuals with HFpEF during the last 3 years of their lives. METHODS/UNASSIGNED:We retrospectively analyzed electronic medical records from 72 centers, mainly in the United States. All patients with HFpEF, identified using International Classification of Diseases codes, who died within 3 years of the diagnosis were selected and then stratified based on receipt of PC consultation. Propensity score matching was used to control for between-group differences. RESULTS/UNASSIGNED:Two hundred twenty-six thousand nine hundred twenty-one patients with HFpEF died within 3 years, only 26.4% of whom received a PC consult. In the unmatched cohort, patients who received a PC consult were more likely to be female, Black, and had more comorbidities. After propensity matching, patients receiving PC consultation were less likely to experience an emergency room visit or hospitalization (2.2% vs 4.6%), surgery or anesthesia (1.1% vs 4.2%), critical care (0.7% vs 1.9%), or receive cardiovascular procedures or tests (1.7% vs 4.7%). Furthermore, they were also less likely to have cardiorespiratory symptoms (2.5% vs 5.7%), heart failure exacerbations (1.6% vs 3.3%), cognitive symptoms (1.7% vs 3.4%), falls (0.3% vs 0.6%), and depression or anxiety (1.3% vs 2.8%). CONCLUSIONS/UNASSIGNED:PC consultation is associated with reduced potential unwanted health care utilization and improvement in symptoms in patients with HFpEF in their last 3 years of life. However, PC continues to be underused in this population.

BACKGROUND:Glucagon-like peptide-1 receptor agonists (GLP-1RAs) promote weight loss and improve heart failure-related symptoms, quality of life, and functional capacity in patients with obesity and heart failure with preserved ejection fraction (HFpEF). However, their clinical effectiveness in nonobese patients with diabetes and HFpEF is understudied. METHODS:The TriNetX research network was used to identify adult patients (≥18 years) with type 2 diabetes mellitus (T2DM), heart failure with preserved ejection fraction (left ventricular ejection fraction ≥45%), elevated brain natriuretic peptide (≥ 150 pg/mL) or N-terminal pro-B-type natriuretic peptide(≥ 450 pg/mL) and a body mass index (BMI) <30 kg/m2 on or before August 31, 2022. Patients were divided into two groups based on GLP-1RA use. After propensity score matching, Cox proportional hazard ratios (HRs) were used to compare outcomes over a 12-month follow-up period. RESULTS:The study included 84,990 patients (n= 42,495 per group, mean age 64 years, 49% females, 65% white). Patients on GLP-1RAs were associated with lower incidence of heart failure exacerbation events (HR 0.60, 95% CI 0.58-0.62, p<0.001) and all-cause emergency room visits or hospitalizations (HR, 0.67, 95% CI 0.66-0.69; P < .001) compared with those not on GLP-1RAs. Other outcomes, including acute myocardial infarction, atrial fibrillation, ischemic stroke, pulmonary hypertension, C-reactive protein ≥ 5 mg/L, acute kidney injury, and the need for renal replacement therapy, were also significantly less frequent in the GLP-1RA group. These associated benefits persisted even among patients on a sodium-glucose cotransporter-2 inhibitor (SGLT2i). CONCLUSION/CONCLUSIONS:GLP-1RA use is associated with improved cardiovascular outcomes in nonobese patients with T2DM and HFpEF and has an associated incremental benefit even among patients on SGLT2i.

BACKGROUND:While cardiovascular benefits of tirzepatide, a glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist in patients with type 2 diabetes mellitus (T2DM), and its comparative effectiveness vs glucagon-like peptide-1 receptor agonists (GLP-1RAs) is studied in randomized controlled trials, real-world outcomes may provide critical insights. OBJECTIVES/OBJECTIVE:The purpose of this study was to examine the cardiovascular benefits of tirzepatide vs GLP-1RA in people living with overweight or obesity, with T2DM, age ≥40 years, and pre-existing ischemic heart disease (IHD). METHODS:receiving either tirzepatide or GLP-1RA were identified and divided into 2 groups (tirzepatide vs GLP-1RA). After propensity score matching, Cox-proportional HRs were used to compare efficacy and safety outcomes during 1-year follow-up. RESULTS:Among 47,719 adults, 753 received tirzepatide, and 46,966 were on GLP-1RA. After propensity score matching, each group had 751 adults (mean age 59.9 ± 8.9 years, 46.5% females, 74.8% White adults in the tirzepatide group). Treatment with tirzepatide was associated with lower primary composite outcomes of acute myocardial infarction, ischemic stroke, and all-cause mortality (HR: 0.60, 95% CI: 0.43-0.84, P < 0.001). Individually, acute myocardial infarction (HR: 0.59, 95% CI: 0.38-0.91) and all-cause mortality (HR: 0.35, 95% CI: 0.14-0.88, P = 0.001) were also found to be favorable in the tirzepatide group. CONCLUSIONS:, and pre-existing IHD.