Functional Impact of GLP-1 for Heart Failure Treatment - FIGHT

Description:

The goal of the trial was to evaluate treatment with the synthetic glucagon-like peptide-1 (GLP-1) agonist liraglutide among high-risk patients with heart failure (HF) and reduced ejection fraction (EF).

Contribution to the Literature: The FIGHT trial failed to show that liraglutide improved cardiovascular outcomes among HF patients.

Study Design

  • Randomized
  • Parallel
  • Blinded
  • Placebo

Patients with HF and reduced EF were randomized to liraglutide (n = 154) versus placebo (n = 146).

  • Total number of enrollees: 300
  • Duration of follow-up: 180 days
  • Median patient age: 61 years
  • Percentage female: 21%
  • Percentage diabetics: 59%

Other salient features/characteristics:

  • 80% with ischemic heart disease
  • 40% with chronic kidney disease
  • Median LVEF = 25%

Inclusion criteria:

  • Patients recently hospitalized with HF and reduced EF (left ventricular EF [LVEF] ≤40%)

Exclusion criteria:

  • Acute myocarditis or acute myocardial infarction
  • Hemodynamically significant arrhythmia
  • Inotrope, or mechanical circulatory support
  • Current or planned LV assist device therapy in next 180 days
  • United Network for Organ Sharing status 1A or 1B
  • B-type natriuretic peptide (BNP) <250 or NT-proBNP <1,000
  • Hemoglobin <8.0 g/dl
  • Glomerular filtration rate <20 ml/min/1.73 m2
  • Systolic blood pressure <80 mm Hg or heart rate >110 mm Hg

Principal Findings:

The frequency of death was 12% in the liraglutide group versus 11% in the placebo group (p = NS) and the frequency of rehospitalization was 41% in the liraglutide group versus 34% in the placebo group (p = NS).

Secondary outcomes: Among diabetic patients, liraglutide was associated with improved weight loss and glycemic control versus placebo.

Interpretation:

Among individuals with advanced HF due to reduced EF, the use of liraglutide did not reduce the frequency of death or hospitalization. Benefit was observed in the outcome of improved weight loss and glycemic control among diabetics with advanced HF.

References:

Effects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. JAMA 2016;316:500-508.

Presented by Dr. Kenneth B. Margulies at the American Heart Association Scientific Sessions, Orlando, FL, November 8, 2015.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Glucagon-Like Peptide 1, Diabetes Mellitus, Heart Failure, Metabolic Syndrome X, Myocardial Ischemia, Weight Loss, Blood Glucose, Renal Insufficiency, Chronic, Secondary Prevention, Stroke Volume, AHA Annual Scientific Sessions


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