Clinical Outcomes of Metabolic Surgery on Diuretic Use in Patients With Heart Failure

•Significant reductions in oral diuretic use were observed, with an average reduction of 65% at 24 months after metabolic surgery.•Decrease in body mass index and total body weight loss observed at 24 months are greater than reported in the general population.•Improvements in hemoglobin A1c levels were sustained ≥24 months postoperatively.•Trends toward less emergency department utilization for cardiac conditions and intravenous diuresis were observed.•Metabolic surgery indicates promising metabolic and cardiac benefits in patients with heart failure. The beneficial impacts of metabolic surgery (MS) on patients with heart failure (HF) are incompletely characterized. We aimed to describe the cardiac and metabolic effects of MS in patients with HF and hypothesized that patients with HF would experience both improved metabolic and HF profiles using glycemic control and diuretic dependency as surrogate markers. In this single-center, university-affiliated academic study in the United States, a review of 2,342 hospital records of patients who underwent MS (2017 to 2023) identified 63 patients with a medical history of HF. Preoperative characteristics, 30-day outcomes, and up to 2-year biometric and metabolic outcomes, medication usage, and emergency department utilization were collected. At 24 months, mean body mass index change was −16 kg/m2 (p