Journal of the American College of Cardiology (JACC)Semaglutide and NYHA Class in Obesity-Related HFpEF

Semaglutide Improves Functional Capacity in Obesity-Related HFpEF: Implications for Heart Failure Management

A recent study published in the Journal of the American College of Cardiology demonstrates the efficacy of semaglutide in improving New York Heart Association (NYHA) functional class for patients with obesity-related heart failure with preserved ejection fraction (HFpEF). The prespecified, pooled analysis of two international, randomized trials provides compelling evidence for the potential of semaglutide as a treatment option in this challenging patient population.

Key Points:

• The study analyzed data from 1,145 patients with obesity-related HFpEF, randomized to receive either once-weekly subcutaneous semaglutide or placebo.
• At baseline, 69% of patients were NYHA class II, 31% were NYHA class III, and two patients were NYHA class IV.
• Semaglutide-treated patients were more likely to experience improvement in NYHA class at 52 weeks compared to placebo (32.6% vs. 21.5%, odds ratio [OR] 2.20, p < 0.001).
• Patients receiving semaglutide were less likely to experience deterioration in NYHA class (2.09% vs. 5.24%, OR 0.36, p = 0.003).
• Benefits of semaglutide were observed as early as 20 weeks into treatment.
• Improvements in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) and reductions in bodyweight were noted across all baseline NYHA classes.
• Patients with NYHA class III/IV at baseline showed greater improvement in KCCQ-CSS compared to NYHA class II patients.
• Consistent benefits of semaglutide were observed across NYHA classes for 6-minute walk distance, C-reactive protein, and N-terminal pro–B-type natriuretic peptide endpoints.
• The study highlights the potential increased benefit of semaglutide for patients with more severe functional limitations at baseline (NYHA class III/IV).
• Results suggest semaglutide may be a valuable treatment option for improving quality of life and functional capacity in patients with obesity-related HFpEF.

Heart failure with preserved ejection fraction (HFpEF) is a common, debilitating syndrome that accounts for nearly half of the 6.6 million cases of heart failure in the US yearly and is known to cause nearly 50% of all hospitalizations for heart failure (HF) in the US. It is associated with a high mortality rate of more than 50% at five years after hospitalization. (Johns Hopkins Medicine)

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