{
  "abstract": "Background GLP-1 receptor agonists are recommended by NICE for weight management and cardiovascular risk reduction in eligible patients with obesity and type 2 diabetes. In aortic stenosis, obesity is associated with earlier symptom onset and increased functional limitation. Beyond metabolic benefits, GLP-1 receptor agonists demonstrate anti-inflammatory and anti-remodelling properties potentially relevant to aortic valve disease. We assessed adherence to NICE guidance for GLP-1 receptor agonist prescribing in patients with severe aortic stenosis undergoing valve replacement.Methods We retrospectively analysed 216 consecutive patients undergoing transcatheter or surgical aortic valve replacement at a single tertiary centre. NICE eligibility for GLP-1 receptor agonist therapy was determined based on BMI ≥35 kg/m 2 with type 2 diabetes, or BMI 30–34.9 kg/m2 with type 2 diabetes and specific comorbidities. Prescription status was extracted from medication records. Chi-square testing assessed the association between eligibility and prescription.Results Of 216 patients, 71 (32.9%) met NICE eligibility criteria for GLP-1 receptor agonist therapy. However, only 7 patients (3.2%) in the entire cohort received a prescription. Among eligible patients, just 2 (2.8%) were prescribed GLP-1 receptor agonists whilst 69 (97.2%) were not. There was no significant association between eligibility and prescription status (χ 2=0.56, p=0.76), indicating prescribing was not targeted to those meeting guideline criteria. Higher BMI patients experienced significantly greater symptom burden (p=0.003) and underwent intervention at younger ages (p=0.005), highlighting the clinical relevance of weight optimisation in this population.Conclusions There is marked underutilisation of GLP-1 receptor agonist therapy in patients with severe aortic stenosis who meet NICE eligibility criteria, with only 2.8% of eligible patients receiving treatment. Given that obesity accelerates symptomatic presentation and earlier intervention in aortic stenosis, this represents a missed opportunity for metabolic optimisation in a high-risk population. Improved adherence to NICE guidance may help delay symptom onset, optimise perioperative status, and potentially modify disease trajectory. Quality improvement initiatives are needed to address this prescribing gap.",
  "authors": [
    {
      "affiliations": [
        "Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom"
      ],
      "name": "Husnain Abid"
    },
    {
      "affiliations": [
        "Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom"
      ],
      "name": "Yusuf Khan"
    },
    {
      "affiliations": [
        "Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom"
      ],
      "name": "Jawad Khan"
    }
  ],
  "title": "56 Adherence to NICE guidance for GLP-1 receptor agonist prescribing in patients with severe aortic stenosis and elevated body mass index",
  "uid": "6ed586ce-5dfb-5224-8e7d-89e9b052f333"
}