Association between Socioeconomic Deprivation and Clinical Outcomes of Glucagon-Like Peptide-1 Receptor Agonists in Heart Failure.

Abstract

The impact of socioeconomic deprivation on the effectiveness and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in heart failure (HF) remains unclear. We evaluated GLP-1RA-associated outcomes across socioeconomic strata and quantified residual disparities among GLP-1RA users. Using the TriNetX Global Network (2020-2024), adults with HF initiating GLP-1RA therapy were categorized as socioeconomically deprived or non-deprived. Cohorts were 1:1 propensity-score matched within each stratum, enabling three comparisons: GLP-1RA users vs non-users in deprived patients, GLP-1RA users vs non-users in non-deprived patients, and deprived vs non-deprived among GLP-1RA users. Cox models estimated adjusted hazard ratios (aHRs) for 12-month mortality and hospitalization outcomes. Among deprived patients, GLP-1RA users (n=22,585) were compared with non-users (n=194,967); among non-deprived patients, users (n=116,439) were compared with non-users (n=2,254,050). In a direct comparison restricted to GLP-1RA users, deprived (n=21,171) and non-deprived (n=104,887) patients were analyzed. GLP-1RA therapy was associated with similar relative reductions in all-cause mortality or hospitalization in deprived (aHR 0.68, 95% CI 0.66-0.70) and non-deprived patients (aHR 0.68, 95% CI 0.67-0.69). However, deprived users had worse outcomes than non-deprived users (35.5% vs 27.1%; aHR 1.50, 95% CI 1.44-1.55), driven by higher hospitalization (aHR 1.53, 95% CI 1.48-1.58) and mortality (aHR 1.13, 95% CI 1.02-1.24). HF exacerbation (aHR 1.11) and ischemic stroke (aHR 1.16) were also increased. GLP-1RA use was associated with similar relative reductions in adverse outcomes across socioeconomic groups; however, socioeconomically deprived patients continued to experience higher absolute event rates, likely reflecting persistent baseline disparities and residual risk.