Effect of GLP-1 Medications on Atrial Fibrillation Burden and Progression
Description: Atrial fibrillation (AF) is an integrative Cardiovascular-Kidney-Metabolic (CKM) outcome that affects approximately 59 million people worldwide. AF progresses over time and contributes substantially to population-level risks of stroke, heart failure, and premature mortality. While anti-arrhythmic medications, catheter ablation, and cardioversion are used to treat AF, these strategies have limited effectiveness. Importantly, weight loss and better control of CKM risk factors reduce AF risk and recurrence. GLP-1 medications, which are rapidly expanding in use, can both reduce weight and improve CKM risk factor control, but the effect of GLP-1s on AF is not well-established; studies have not reliably or rigorously examined this important endpoint. Understanding whether GLP-1 therapies reduce AF burden and progression has important implications for prevention and treatment selection for millions of people. In this proposed research, an investigator team based at the University of California, San Francisco (UCSF) and Department of Veterans Affairs (VA) will provide evidence of the effect of GLP-1s on the burden and progression of AF. This study will use a combined dataset of more than 17,000 patients with type 2 diabetes mellitus who initiated GLP-1s vs other medications (DPP-4 inhibitors or SGLT-2 inhibitors) and who have pacemakers, implantable cardioverter-defibrillators (ICDs), and implantable loop recorders (ILRs). These devices provide granular AF burden data on a daily basis through remote monitoring, and these data are complemented by clinician-adjudicated data about the longest continuous duration of AF that these patients have experienced at each remote transmission. Continuous cardiac monitoring with clinician adjudication is the reference standard for identifying cardiac arrhythmias. Using a target trial emulation framework incorporating propensity weighting and falsification endpoints, this study will determine the effect of GLP-1 medications on both the burden and longest duration of AF vs comparator medications for type 2 diabetes. Further, this study will determine the effect of GLP-1 medications on AF recurrence after catheter ablation or cardioversion for AF using quasi-experimental methods. Thus, using a rigorous dataset with continuous cardiac monitoring, this study will provide robust, real-world evidence to inform clinical and population-level decision-making about GLP-1s impact on AF, a manifestation of multi-system CKM disease.
Funder: American Heart Association
Amount: $300,000
Funding type: research
Funder scheme: GP1 Medications Among Individuals with CKM Disease
Start date: 2026-07-01
End date: 2028-06-30
Investigators: Sanket Dhruva, Sanket Dhruva
Institution: The Regents of the University of California, San Francisco
Funded outputs count: 0
Funder award ID: 26GLPCKMD1642311
OpenAlex ID: G3124407053