Summary:
In 1,145 patients with obesity-related HFpEF (BMI ≥30, LVEF ≥45%) with NYHA class II-IV symptoms, semaglutide 2.4 mg subcutaneous weekly for 52 weeks significantly improved NYHA functional class (32.6% improved ≥1 class), with consistent KCCQ and physical function improvements across baseline NYHA categories compared to matching placebo, with similar weight reduction (~8%) regardless of baseline NYHA class and fewer patients experiencing deterioration.
| PICO | Description |
|---|---|
| Population | 1,145 patients with obesity-related HFpEF (BMI ≥30, LVEF ≥45%), NYHA class II-IV. |
| Intervention | Semaglutide 2.4 mg subcutaneous weekly for 52 weeks, titrated per standard protocol. |
| Comparison | Matching placebo weekly for 52 weeks, double-blind randomized. |
| Outcome | 32.6% improved ≥1 NYHA class. Fewer deteriorated. Weight -8% consistent across NYHA classes. |
Semaglutide and NYHA Class in Obesity-Related HFpEF
STEP-HFpEF program · obesity-related HFpEF · 52 weeks
More semaglutide-treated patients improved ≥1 NYHA class (32.6% vs 21.5%; OR 2.20), and fewer deteriorated, with consistent symptom and weight benefits across baseline NYHA categories.
Clinical Context
HFpEF accounts for half of heart failure cases. The obesity-HFpEF phenotype causes progressive exercise intolerance and functional decline.
Clinical Pearls
1. NYHA Improvement Is Clinically Meaningful: Nearly one-third moved up at least one functional class.
2. Bidirectional Effect: Promotes improvement and prevents deterioration.
3. Consistent Benefit Across Baseline Severity: Patients at NYHA II, III, or IV all benefited.
4. Weight Loss Consistent Across NYHA Classes: ~8% reduction regardless of baseline functional status.
Practical Application
Consider semaglutide for obesity-related HFpEF across NYHA classes II-IV. Use NYHA and KCCQ to track response.
Study Limitations
NYHA has subjective components. Hard outcomes not powered. 52-week duration.
Bottom Line
Semaglutide improves NYHA class in nearly one-third of obesity-related HFpEF patients, with consistent benefits across baseline severity.
Source: Schou M, et al. “Semaglutide and NYHA Functional Class in Obesity-Related HFpEF.” J Am Coll Cardiol. 2024. Read article