Finally, the associations with lower NT-proBNP levels and a higher heart rate could reflect biological effects of GLP-1 RA.6,16 The effect on heart rate should not discourage from the use of GLP-1 RA in HF; instead, it needs to be counteracted with appropriate re-evaluation and dose optimization of beta-blockers and ivabradine. This evidence concerns the gene NPPB and hydrops fetalis.