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Semaglutide in Obesity-HFpEF — EECC MCQ

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ModerateHeart FailureSemaglutide in Obesity-HFpEFEECC

A 72-year-old woman with HFpEF (LVEF 58%) and obesity (BMI 40) is started on semaglutide 2.4 mg weekly for weight management. The STEP-HFpEF trial results are discussed. What was the primary finding?

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Correct answer: B — Semaglutide improved HF symptoms (KCCQ score) and functional capacity (6MWD) and reduced body weight, but is not yet incorporated into ESC HF guideline recommendations

The STEP-HFpEF trial (2023) demonstrated that semaglutide 2.4 mg weekly in obese HFpEF patients (with and without diabetes) significantly improved the Kansas City Cardiomyopathy Questionnaire (KCCQ) score (symptoms and quality of life), 6-minute walk distance, and reduced body weight compared with placebo. However, it was not powered for mortality or HF hospitalisation endpoints. While these results are promising for the obesity-HFpEF phenotype, semaglutide is not yet included in ESC HF guideline recommendations for HFpEF (pending larger outcome trials). SGLT2 inhibitors remain the only Class I recommended pharmacotherapy for HFpEF.

Reference: STEP-HFpEF Trial; ESC (2023): HF Guidelines