Could semaglutide help obese patients with heart failure?

STEP-HFpEF was a randomised, controlled trial designed to find out whether semaglutide for 52 weeks could improve heart failure symptoms and physical function in obese, non-diabetic patients with heart failure with preserved ejection fraction (HFpEF). IMI spoke to Vicky Ruszala, Specialist Cardiology Pharmacist, North Bristol NHS Trust to find out more.

HFpEF – commonly known as ‘hef-pef’ – refers to heart failure with preserved ejection fraction, in contrast to HFrEF (‘hef-ref’), which is heart failure with reduced ejection fraction. Ms Ruszala explains, “the gold standard for diagnosing heart failure is with an echocardiogram and that will measure lots of different things in the heart …….. and one of the measurements that we are given is the ejection fraction, which is how much blood is pumped out of your left ventricle into the body and that’s called your ejection fraction”. An ejection fraction of less than 40 percent is associated with the classical symptoms of heart failure. This was formerly known as congestive heart failure but is now described as heart failure with reduced ejection fraction (HFrEF). It is also possible to have symptoms of heart failure with an ejection fraction of 49 percent or more and such patients “may have may have structural abnormalities within their heart, so, for example, valvular abnormalities or they may have dilated ventricles”, explains Ms Ruszala.   The HFpEFs are “not new – we’ve known about them for years but we’ve never had anything we can really do to treat – it’s always been a disease of ….. comorbidities”, emphasises Ms Ruszala.

Current thinking suggests that obesity may be a causative factor in HFpEF rather than a co-morbidity. “In the U.S. about 80 percent of patients with HFpEF also have obesity and it was kind of, you know …… chicken and egg – which one came first”, she says.  Therefore, STEP-HFpEF was designed to investigate whether treating obesity in such patients had an impact on their heart failure. “This was looking at – if we treat obesity do we treat the heart failure alongside. Semaglutide is well-known in the type 2 diabetes and obesity world for causing huge weight loss and therefore improving lots of different outcomes”, she says.

The trial had a dual primary endpoints comprising quality of life (using the Kansas City Cardiomyopathy Questionnaire (KCCQ) score) and weight loss. “The KCCQ was designed for heart failure patients and looks at improvements in quality of life, signs and symptoms and exercise capacity”, explains Ms Ruszala.

About Vicky Ruszala

As a specialist cardiology pharmacist, a large part of Vicky Ruszala’s work involves optimising medications for heart failure. She works on the specialist cardiology ward and also has two heart failure clinics each week.  She is an independent prescriber and has her own patient caseload.

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