---
type: source
title: "Semaglutide and Hospitalizations in Patients With Obesity and Established CVD: SELECT Trial Exploratory Analysis"
author: "JAMA Cardiology (peer-reviewed)"
url: https://pubmed.ncbi.nlm.nih.gov/41433034/
date: 2025-12-23
domain: health
secondary_domains: [internet-finance]
format: paper
status: enrichment
priority: high
tags: [glp-1, semaglutide, hospitalization, cardiovascular, SELECT-trial, cost-offset]
processed_by: vida
processed_date: 2026-03-16
enrichments_applied: ["glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Prespecified exploratory analysis of the SELECT trial published in JAMA Cardiology, examining hospitalization outcomes for semaglutide vs. placebo in patients with obesity and established cardiovascular disease (N=17,604; median follow-up 41.8 months).

Key findings:
- Total hospitalizations for any indication: 18.3 vs 20.4 admissions per 100 patient-years (mean ratio 0.90; P<.001) — 10% reduction
- Hospitalizations for serious adverse events: 15.2 vs 17.1 per 100 patient-years (mean ratio 0.89; P<.001) — 11% reduction
- Days hospitalized for any indication: 157.2 vs 176.2 days per 100 patient-years (rate ratio 0.89; P=.01) — 11% reduction
- Benefits extended beyond cardiovascular — overall hospitalization burden reduced

Median age 61.0 years; 27.7% female; median BMI 32.1.

## Agent Notes
**Why this matters:** Hospitalization is the single largest cost category in healthcare. A 10% reduction in all-cause hospitalizations has enormous economic implications for risk-bearing entities. This is NOT just cardiovascular hospitalizations — it's total hospitalizations, suggesting systemic benefits beyond the primary CV mechanism.
**What surprised me:** The hospitalization reduction extended beyond cardiovascular causes. An 11% reduction in ALL hospital days is a much bigger economic signal than the 20% reduction in CV events alone. For MA plans bearing full capitation risk, this is the number that matters most.
**What I expected but didn't find:** No cost quantification in the paper itself. No breakdown by hospitalization type beyond CV vs. all-cause.
**KB connections:** Connects to [[the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness]] — hospitalization reduction is the mechanism through which prevention-first models profit.
**Extraction hints:** Potential claim about GLP-1s reducing ALL-CAUSE hospitalization (not just CV), which has broader implications for VBC economics than the CV-specific SELECT primary endpoint.
**Context:** Exploratory analysis — not the primary endpoint — but from a well-designed, large RCT. The broad hospitalization reduction signal is mechanistically plausible given anti-inflammatory and metabolic effects.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness]]
WHY ARCHIVED: All-cause hospitalization reduction is the most economically relevant outcome for risk-bearing payers and the strongest evidence that GLP-1s could be cost-saving under capitation
EXTRACTION HINT: Focus on the all-cause hospitalization signal (not just CV) — this is what makes GLP-1s relevant to VBC economics beyond cardiology


## Key Facts
- SELECT trial: N=17,604 patients with obesity and established CVD, median follow-up 41.8 months
- Median age 61.0 years, 27.7% female, median BMI 32.1
- Total hospitalizations: 18.3 vs 20.4 per 100 patient-years (mean ratio 0.90, P<.001)
- Hospitalizations for serious adverse events: 15.2 vs 17.1 per 100 patient-years (mean ratio 0.89, P<.001)
- Days hospitalized: 157.2 vs 176.2 per 100 patient-years (rate ratio 0.89, P=.01)
- Published in JAMA Cardiology as prespecified exploratory analysis
