In obese patients receiving durable left ventricular assist devices (LVADs), obesity increases device-related morbidity and may limit access to heart transplantation, while the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remains undefined. We performed a retrospective propensity-matched cohort study using the TriNetX US Collaborative Network of adults with obesity who underwent durable LVAD implantation in the United States between 2016 and 2024. Patients with documented GLP-1 RA exposure before implantation were matched 1:1 to nonusers on demographics and baseline comorbidities. The primary outcome was all-cause mortality; secondary outcomes included driveline infection, device malfunction, sepsis, bleeding complications, transplant listing, and heart transplantation at 1 and 3 years. Among 527 obese LVAD recipients, 231 had documented preimplant exposure. After matching, 141 patients were analyzed in each group. At 1 year, exposed patients had a lower hazard of driveline infection. At 3 years, nonusers had higher all-cause mortality, whereas exposed patients had higher rates of transplant listing and heart transplantation. Documented preimplant GLP-1 RA exposure was associated with improved longer-term survival, fewer driveline infections, and greater progression to transplant-related outcomes. These findings are observational and hypothesis-generating but support prospective evaluation in selected LVAD recipients.
