A myriad of landmark breakthroughs from 2025 demonstrate that the clinical impact of modern therapeutics – including tirzepatide in heart failure – depends as much on disciplined hospital pharmacy implementation as it does on scientific innovation, as Dr João Gonçalves PhD explains as he shares part three of his top five highlights from 2025.
The cardiometabolic field in 2025 has shifted significantly from emphasising surrogate benefits to focusing on outcomes that directly impact hospital utilisation. Heart failure with preserved ejection fraction (HFpEF) associated with obesity is a clinical area characterised by high symptom burden, frequent hospital admissions and, historically, limited therapeutic options.
In January, the SUMMIT trial reported that tirzepatide reduced the risk of cardiovascular death or worsening heart failure events and improved health status in patients with HFpEF and obesity.1
This is an important discovery for hospital pharmacy: it transforms incretin-based therapies from being seen mainly as metabolic agents into treatments with a growing relevance to cardiology, affecting formulary decisions and multidisciplinary pathways.
Yet randomised trials alone rarely determine practice at scale. What gave 2025 additional momentum was the emergence of comparative effectiveness evidence in real-world cohorts.
A large observational study, published in JAMA in August, assessed semaglutide and tirzepatide in patients with cardiometabolic HFpEF using claims data, reporting significant reductions in the composite outcome of heart failure hospitalisation or all-cause mortality compared with a placebo proxy, and no meaningful head-to-head advantage for tirzepatide versus semaglutide.2
While observational methods require careful interpretation, the existence of large-scale real-world signals accelerates policy discussions in hospitals, especially where budget impacts and equitable access are under scrutiny.
Safety and workflow challenges of tirzepatide
For hospital pharmacy, the immediate practical implication is clear: incretin-based therapies such as tirzepatide are increasingly encountered in admitted patients, during peri-procedural care and at discharge.
This creates safety and workflow challenges because incretins are associated with dehydration risk, nausea and vomiting, potential triggers of acute kidney injury and clinically important interactions when used alongside insulin or sulfonylureas.
In many hospitals, management remains inconsistent across clinical services and procedural pathways.
If incretins such as tirzepatide improve outcomes in HFpEF populations, hospitals will face increased demand and must determine where initiation should occur (inpatient versus outpatient), how to manage peri-procedural holding and re-initiation, and how to document patient education reliably.
A scientifically justified approach for hospital pharmacy is to implement a minimum viable level of standardisation that can be applied consistently at scale. This would involve a peri-procedural protocol shared across anaesthesia, endoscopy and surgical services; an inpatient guide to support the management of adverse events from therapies such as tirzepatide and adjustment of concomitant therapies; and formulary criteria that are evidence-based yet practical to enforce in routine care.
The final point is crucial. An ‘open access’ system risks causing budget shocks and uneven benefits, whereas an overly restrictive approach can undermine outcomes and the continuity of care. A pharmacist-led, evidence-based model can safeguard both clinical value and system sustainability.
Next, read part four of this 2025 highlights series on oral gepotidacin for gonorrhoea and part five on medication safety and artificial intelligence. Make sure to also catch up on part one on CAR-T therapy for autoimmune disease and part two on radioligand therapy for prostate cancer.
Author
João Gonçalves PharmD PhD
Faculty of Pharmacy, University of Lisbon and Imed Research Institute for Medicines, Lisbon, Portugal
References
1 Packer M et al. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med 2025;392(5):427–37.
2 Krüger N et al. Semaglutide and Tirzepatide in Patients With Heart Failure With Preserved Ejection Fraction. JAMA 2025;334(14):1255–66.
