Observational EHR study suggests GLP-1 RA may have lower risk than SGLT2i for HF outcomes

This observational study used real-world electronic health record data from Stony Brook University Hospital to compare the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RA) versus sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with heart failure. The primary outcome was a 1-year composite of all-cause mortality or heart failure-related hospitalization. The analysis, which employed causal machine learning methods, found that GLP-1 RA use was associated with a lower risk for this composite outcome compared to SGLT2i use. Specific effect sizes, absolute numbers, p-values, and confidence intervals were not reported. Safety and tolerability data were also not reported. The study has important limitations. The authors note there is limited evidence for individualized treatment selection based on this analysis. Subgroup tests suggested that loop diuretic use, body mass index, and estimated glomerular filtration rate may be potential effect modifiers, but these findings are exploratory. The authors emphasize that careful assessment of causal assumptions and rigorous validation are essential before any clinical implementation. While the analytical models show promise for translating observational data into precision care insights, this remains a preliminary, hypothesis-generating study from a single center. Its practice relevance is currently restrained to highlighting areas for future prospective research.