Written by Babatunde Carew
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Tirzepatide significantly reduces heart failure events, improves quality of life, and promotes substantial weight loss in patients with heart failure with preserved ejection fraction (HFpEF) and obesity.
Not just for weight loss anymore
SUMMIT was randomized, double-blind, placebo-controlled trial (731 patients with HFpEF and obesity, median follow-up: 104 weeks) evaluated tirzepatide versus placebo. The two primary outcomes were a composite of cardiovascular death or worsening heart failure events and change in Kansas City Cardiomyopathy Questionnaire (KCCQ-CSS) – a measure of quality of life. Tirzepatide reduced composite events (9.9% vs. 15.3%, HR 0.62, p=0.026) powered largely by a reduction in hospitalizations and uptitration of diuretics (8.0% vs 14.2%, HR 0.54 (0.34 to 0.85)) and improved KCCQ-CSS (19.5 vs. 12.7, Δ6.9 points, p<0.001), but had no significant effect on cardiovascular deaths. Secondary endpoints included greater weight loss (−13.9% vs. −2.2%, p<0.001) and improved 6-minute walk distance (+18.3m, p<0.001). This study provides more support for the 2023 ACC expert consensus report that weight loss interventions are known to improve exercise tolerance and reduce heart failure events in patients with HFpEF and obesity. Limitations of the study include a relatively small sample size in comparison to prior GLP1a trials in a similar population and exclusion of patients with a BMI < 30 with increased visceral adiposity (as may be evidenced by an abnormal waist-to-height ratio).
How does this change my practice?
This study supports my current practice of starting patients with HFpEF and obesity on a GLP1a or dual GIP and GLP1a if possible. Cost remains an issue, as tirzepatide is just under $1,000 on GoodRx. Since no head-to-head studies have shown superiority of one GIP/GLP1a to another in this population, I will prescribe whichever of these agents insurance will cover. Unfortunately, in my experience, in patients that do not have diabetes, prior authorization is often declined regardless of comorbidities.
Source
Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2024 Nov 16. doi: 10.1056/NEJMoa2410027. Epub ahead of print. PMID: 39555826
