Clinical Profile and Prognosis of Patients With Acute Decompensated Heart Failure Who Met the Obesity-Related Eligibility for Subcutaneous Semaglutide　― Findings From the CURE-HF Registry

• Published in: Circulation Reports Vol. 7; no. 6; pp. 463 - 472
• Main Authors: Nishikawa, Ken, Minamisawa, Masatoshi, Yoshie, Koji, Suzuki, Sho, Tanaka, Kiu, Okuma, Yukari, Kimura, Kazuhiro, Ueki, Yasushi, Oguchi, Yasutaka, Kato, Tamon, Saigusa, Tatsuya, Ebisawa, Soichiro, Okada, Ayako, Motoki, Hirohiko, Kuwahara, Koichiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 10.06.2025
• Subjects: Body mass index; Heart failure; Obesity; Original; Prognosis; Heart failure; Body mass index; Obesity; Prognosis
• ISSN: 2434-0790; 2434-0790
• DOI: 10.1253/circrep.CR-25-0041

Background: Obesity is well-established risk factor of heart failure (HF); however, “obesity paradox” has been described in symptomatic HF patients. The STEP-HFpEF study suggested that once-weekly subcutaneous semaglutide might improve outcomes in patients with obesity-related HF. We explored the prevalence of obesity-related eligibility for semaglutide treatment among patients with acute decompensated heart failure (ADHF) and evaluated their prognoses.Methods and Results: We analyzed data from 1,017 ADHF patients (median, 81 years; 44.2% female) enrolled in the CURE-HF registry. We assessed prevalence of obesity-related eligibility for semaglutide administration and examined the association between this eligibility and all-cause death over a median follow-up of 2.7 years. There were 73 patients (7.2%) who were semaglutide-eligible and they had a higher proportion of diabetes mellitus than patients who were semaglutide non-eligible (64.4% vs. 26.4%, P<0.001). Kaplan-Meier analysis indicated that semaglutide-eligible patients had a significantly lower all-cause mortality rate than non-eligible patients (log-rank P=0.005). After adjustment for demographic characteristics, there was no significant difference in mortality rate between the 2 groups (adjusted hazard ratio 0.63, 95% confidence interval (CI) 0.34–1.17, P=0.14). In the propensity score-matched cohort, we did not observe a significant difference in mortality rate (log-rank, P=0.79).Conclusions: Almost 7.2% of the ADHF patients were semaglutide-eligible. Our findings did not affirm the “obesity paradox” in semaglutide-eligible HF patients after adjusting for demographic factors.