Where do GLP-1 receptor agonists fit in heart failure care?

Prof. Adriaan Voors discusses the evolving role of GLP-1 receptor agonists in heart failure, the importance of patient selection and monitoring, and how emerging evidence and new guidelines could influence clinical practice.

The role of GLP-1 receptor agonists in cardiovascular medicine continues to expand, with growing interest in how these therapies might benefit selected patients with heart failure, particularly those with heart failure with preserved ejection fraction (HFpEF) and overweight or obesity.

At ESC Congress 2026, Professor Adriaan Voors, University Medical Center Groningen, Groningen, the Netherlands, participated as a discussant in the Great Debate, Should all patients with heart failure be treated with GLP-1 receptor agonists? Ahead of the session, he spoke with touchCARDIO about where GLP-1 receptor agonists currently fit in heart failure care, the practical considerations around their use, and the evidence still needed to define their role more clearly.

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What is the current role of GLP-1 receptor agonists in patients with heart failure?

At the moment, the recommendation is relatively modest and is mainly focused on patients with HFpEF who are also overweight. In those patients, GLP-1 receptor agonists are not positioned in the same way as the fundamental heart failure therapies. They are more of an add-on treatment.

That is the way the newer guidelines are beginning to approach them: not as a replacement for established heart failure therapy, but as an additional option in appropriately selected patients.

What cautions should cardiologists consider when prescribing GLP-1 receptor agonists in heart failure?

First of all, it is important to identify the right patient population.

You also need to follow patients carefully, particularly with regard to renal function. There have been a lot of discussions about the potential renal benefits of these therapies, but there may also be an initial decline in renal function. Clinicians should not necessarily panic if they see that initial dip, but they should monitor it.

The general side-effect profile also needs to be taken into consideration. These agents are already used by a very large number of patients, including outside cardiology, so we have accumulated considerable experience with the types of side effects that may occur.

In that sense, I do not think the principle is fundamentally different from prescribing beta-blockers or other cardiovascular drugs. You need to understand the expected effects, understand the side effects, select the right patient, and monitor them appropriately.

How are you currently using these therapies in your own clinical practice?

At the moment, I am actually not yet prescribing these agents myself because we are not currently able to do so within this indication.

There is an indication for patients who are overweight and who follow a specific program through primary care, but there is not yet reimbursement for providing these agents specifically to patients with HFpEF.

So, at present, we are waiting for that to change before they can become part of routine prescribing in this population.

Is further evidence needed before we fully understand the place of GLP-1 receptor agonists in heart failure?

Definitely. There is already a lot of data, but the evidence we have so far also has limitations.

There is now a whole program of studies underway that should help address some of the gaps in our knowledge. Importantly, these include large outcome studies, which should give us a much clearer understanding of the clinical effects of these therapies.

We are eagerly awaiting those results because they should strengthen the level of evidence and help us define the indication more clearly.

I think the most likely target population will continue to be patients with HFpEF who are also overweight, but we need stronger outcome data to understand exactly how these therapies should be used, which patients benefit most, and how confidently they can be incorporated into routine heart failure management.