No abstract

Within the FIGHT study population, Carbone and colleagues inquire about how quantitative differences in LVEF affected responses to liraglutide within the larger population of patients with advanced heart failure and reduced LVEF. In the requested subgroup analysis (Table ), liraglutide treatment was associated with signals of worse outcomes among patients with an LVEF above the median (25%), but responses were not significantly different from placebo among those with an LVEF at or below the median. Owing to the entry criteria of the FIGHT trial, even the group with LVEF above the median had severely reduced systolic function and other factors indicating increased risk. Nevertheless, a greater severity of LVEF reduction does not appear to be driving adverse effects of liraglutide within a population composed of patients with advanced heart failure.Carbone and colleagues also consider the possible effect of body composition on responses to GLP-1 agonists and inquire whether patients' BMI or weight loss during the trial affected their responses to liraglutide. Specifically, there is concern that further weight loss among already cachectic patients may have contributed to adverse outcomes. In this context, it is important to highlight that in the FIGHT cohort, the median (interquartile range) BMI was 32 (26-37). The requested subgroup analysis (Table ) indicates that liraglutide treatment was not associated with worse outcomes among patients with BMI at or above or below the median. Unlike baseline BMI, the magnitude of weight loss cannot be predicted at onset of treatment and thus cannot influence the decision to prescribe liraglutide in patients with advanced heart failure.Overall, it appears that the safety concerns about liraglutide among patients with advanced heart failure arise specifically regarding patients with type 2 diabetes. These findings underscore our suggestion for caution when initiating liraglutide for the sake of diabetes management among patients with advanced heart failure.