Current Problems in Cardiology · Nov 1, 2026

Association of GLP-1 receptor agonist and SGLT2 inhibitor use with outcomes in patients with type 2 diabetes undergoing pacemaker implantation

By Avidan Y, Jonas M, Hadar D et al.

Aims Heart failure (HF) remains prevalent following pacemaker implantation, with patients with type 2 diabetes mellitus (T2DM) representing a particularly vulnerable population. Whether use of contemporary glucose-lowering therapies is associated with subsequent clinical outcomes has not been well characterized. We investigated the associations of sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, individually and in combination, with post-implantation clinical outcomes. Methods Electronic health records identified 3,609 patients with T2DM who underwent pacemaker implantation from 2016–2023. Based on peri-implantation medication dispensing, patients were classified as SGLT2i (n = 438), GLP-1RA (n = 193), combined therapy (n = 231), or neither (n = 2,747). Following a 90-day landmark period, three-year risks of all-cause mortality and HF hospitalization were evaluated using multinomial propensity score-based inverse probability of treatment weighting and Cox proportional hazards models. Results Overall, 463 patients (12.8%) died. All treatment groups showed lower all-cause mortality than controls, with the greatest reduction observed in the combination therapy group (HR 0.41; 95% CI, 0.22–0.77; P = 0.006). HF hospitalization occurred in 295 patients (8.2%), significantly reduced in combination therapy (HR 0.35; 95% CI, 0.17–0.74; P = 0.006), with trends toward benefit in monotherapy groups. Conclusions Among patients with T2DM undergoing permanent pacemaker implantation, SGLT2i and GLP-1RA therapy were associated with lower all-cause mortality, while combined therapy was additionally associated with fewer HF hospitalizations. These findings support further evaluation of cardiometabolic therapies after pacemaker implantation in randomized trials.

doi.org/10.1016/j.cpcardiol.2026.103492PubMed 42967552Populations