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In HFrEF, an issue remains that because GLP-1 RAs have been shown to modestly increase heart rate (2-3 beats per minute) owing to their chronotropic effects (see Mechanisms) (Sun et al., 2015), GLP-1 RA treatment in HFrEF may be problematic considering that, in line with the use of beta-blockers to ameliorate HFrEF (11, 12), heart rate elevations may result in a worse outcome (Ibrahim et al., 2019)

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But during a prep phase when exogenous T3 is being utilised there isnt really a need for the use of T4 only at replacement levels

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