Nurse Practitioner-Led Integration of Glucagon-Like Peptide-1 Receptor Agonists in Patients With Obesity-Related Heart Failure With Preserved Ejection Fraction: A Prospective Clinical Effectiveness Study

BACKGROUND: Obesity-related heart failure with preserved ejection fraction (HFpEF) is characterized by systemic inflammation and reduced functional capacity. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve symptoms and weight in randomized trials, but uptake in routine cardiovascular practice is inconsistent. OBJECTIVE: The purpose of this study was to evaluate a structured nurse practitioner-led program for GLP-1 RA initiation in obesity-related HFpEF. METHODS: Prospective 12-month, single-center pre-post effectiveness study at a U.S. urban academic outpatient cardiology clinic. Adults with left ventricular ejection fraction ≥45%, body mass index ≥30 kg/m2, New York Heart Association class II-III symptoms, and at least 1 cardiometabolic comorbidity were enrolled. The intervention included registry-based identification, baseline assessment, patient education, protocolized titration, and longitudinal follow-up. Each participant's 12-month preenrollment period served as a comparator. The primary outcome was GLP-1 RA initiation and 12-month persistence. RESULTS: Of 156 enrolled, 128 (82.1%) completed follow-up. Mean age 67.4 ± 11.2 years; 61.7% female; 43.8% Black. GLP-1 RA use rose from 7.8% to 92.2% (87.5% at target dose). Mean weight decreased 6.2 ± 3.8 kg, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score improved 16.6 ± 11.3 points, and 6-minute walk distance rose 48.3 ± 36.2 m (all P < .001). Systolic blood pressure, hemoglobin A1c (diabetic subgroup), high-sensitivity C-reactive protein, and N-terminal pro-B-type natriuretic peptide all decreased significantly. Heart failure hospitalization fell from 18.2% to 4.7% (P = .002). Gastrointestinal symptoms were most common; 4.7% discontinued for intolerance. CONCLUSIONS: A structured nurse practitioner-led cardiometabolic program was associated with high GLP-1 RA initiation and persistence and with clinically meaningful improvements in symptoms, function, and hospitalization in obesity-related HFpEF.