Abstract Body (Do not enter title and authors here):
Background:
Patients with left ventricular assist devices (LVADs) experience high mortality and infection-related complications. While Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in various populations, their safety and efficacy in advanced heart failure patients on mechanical support remain understudied.

Methods:
We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Using ICD-10 and procedural codes, adults with a diagnosis of LVAD (ICD-10: Z95.811) and a history of LVAD-related procedures were identified. Only GLP-1 RAs with proven cardiovascular outcomes -liraglutide, dulaglutide, semaglutide, and tirzepatide- were included. Patients exposed to GLP-1 RAs after LVAD placement formed the GLP1 RA group. Those without GLP-1 RA exposure comprised the control group. Propensity score matching (1:1) was performed on demographics, comorbidities (diabetes, chronic kidney disease, obesity, ischemic heart disease, atrial fibrillation), and medications. Outcomes were assessed over a 5-year follow up period from the index date. The primary outcome was all-cause mortality. Secondary outcomes included hospitalization, device infections, endocarditis, and MRSA/MSSA bloodstream infections.

Results:
After matching , 543 patients were included in each cohort. The GLP1 group showed significantly lower mortality (17.3% vs. 33.9%, HR 0.40, 95% CI: 0.31–0.51, p<0.001) and higher 5-year survival probability (70.3% vs. 45.6%). Hospitalization was also reduced (69.6% vs. 82.5%, HR 0.44, p<0.001), with longer median time to first admission (241 vs. 34 days). Bloodstream infections were significantly lower in GLP-1 users (20.4% vs. 26.5%, HR 0.61, p=0.001). Device-specific infections was similar in both cohorts (HR 0.86, p=0.13). Endocarditis showed a favorable trend among the GLP-1 RA group but did not reach statistical significance (HR 0.52, p=0.050), possibly due to limited statistical power.

Conclusion:
In this large real-world analysis, GLP-1 RA use in patients with LVADs was associated with significantly lower long-term mortality, reduced hospitalizations, and fewer bloodstream infections. Although device-specific infections were unaffected, these findings provide observational evidence suggesting possible cardiovascular and infection-related benefits of GLP-1 RAs in advanced heart failure populations. Prospective studies are warranted to confirm safety and efficacy in this unique cohort.