JAMA CardiolHeart & CardiovascularRCTDecember 23, 2025

Semaglutide and Hospitalizations in Patients With Obesity and Established Cardiovascular Disease: An Exploratory Analysis of the SELECT Randomized Clinical Trial.

Nicholls SJ, Ryan DH, Deanfield J, Ferreira D, Lang CC, Lincoff AM, Lingvay I, Lübker C, Terns PP, Rasmussen S, Stensen S, Weeke PE, Kahn SE, SELECT Trial Investigators

View on PubMed DOI: 10.1001/jamacardio.2025.4824

Key Finding

Semaglutide reduced hospital stays by 11% in people with obesity and heart disease, preventing 2 hospitalizations and 19 hospital days per 100 patients per year.

What This Study Found

Think of hospitals like expensive hotels you never want to visit - this massive study of over 17,600 people with obesity and established heart disease found that semaglutide acts like a protective shield, keeping people out of these unwanted stays. Over nearly 3.5 years of follow-up, patients taking weekly semaglutide 2.4mg were hospitalized less frequently than those on placebo - like having a better immune system that prevents you from getting sick enough to need hospital care. The effect was consistent across different ages, weights, and genders, suggesting this isn't just luck but a real protective benefit. While we already knew semaglutide reduces heart attacks and strokes, this analysis reveals an additional layer of benefit: it keeps people healthier overall, reducing the cascade of health problems that land people in hospital beds.

Statistics Decoded

The numbers tell a compelling story: For every 100 patients treated for one year, semaglutide prevented about 2 hospital admissions (18.3 vs 20.4 per 100 patient-years). The mean ratio of 0.90 means semaglutide patients had 10% fewer hospitalizations - this wasn't just chance (P<0.001 is like flipping heads 1000 times in a row). Hospital days were cut by 19 days per 100 patients yearly (157.2 vs 176.2 days), an 11% reduction. The 95% confidence intervals (0.85-0.95 for admissions, 0.82-0.98 for days) mean we're quite confident the real benefit falls within these ranges - all favoring semaglutide.

Why This Matters

This extends semaglutide's value beyond just weight loss and heart protection to keeping people out of hospitals altogether, potentially saving healthcare systems millions while improving quality of life. For patients with obesity and heart disease, this means fewer disruptions to life, less time away from family and work, and reduced healthcare costs.

Original Abstract

The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. ClinicalTrials.gov Identifier: NCT03574597.