This meta-analysis of 14 studies involving 18,558 heart failure patients found GLP-1 receptor agonists like semaglutide reduced all-cause mortality by 13% (HR 0.87) and improved quality of life scores by 7.4 points, but narrowly missed statistical significance for the primary composite endpoint of cardiovascular death plus heart failure hospitalization (HR 0.86, P=0.067). The mortality benefits emerged primarily from cardiovascular outcomes trial subgroups rather than dedicated heart failure studies, which actually showed directional harm in some cases. This discrepancy represents a critical limitation that complicates clinical interpretation. The strongest evidence supports GLP-1 agonists specifically in heart failure with preserved ejection fraction patients who have obesity, where functional improvements were most pronounced. Given the exploding use of these medications for weight loss and diabetes, understanding their cardiovascular effects becomes increasingly vital for patient safety. However, as this is a preprint awaiting peer review, these findings require validation before influencing clinical practice. The mixed signals between indirect and direct evidence suggest more targeted research is needed.