The effect of omecamtiv mecarbil in hospitalized patients as compared with outpatients with HFrEF: an analysis of GALACTIC-HF

Docherty, K. F. et al. (2023) The effect of omecamtiv mecarbil in hospitalized patients as compared with outpatients with HFrEF: an analysis of GALACTIC-HF. Journal of Cardiac Failure, (doi: 10.1016/j.cardfail.2023.08.020) (In Press)

Abstract

BACKGROUND: In the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil, compared with placebo, reduced the risk of worsening heart failure (HF) events or cardiovascular death in patients with HF and reduced ejection fraction (HFrEF). The primary aim of this prespecified analysis was to evaluate the safety and efficacy of omecamtiv mecarbil by randomization setting i.e., whether participants were enrolled as outpatients or inpatients. METHODS AND RESULTS: Patients were randomized either during a HF hospitalization or as an outpatient, within one year of a worsening HF event (hospitalization or emergency department [ED] visit). The primary outcome was a composite of worsening HF event (HF hospitalization or an urgent ED or clinic visit) or cardiovascular death. Of the 8232 patients analyzed, 2084 (25%) were hospitalized at randomization. Hospitalized patients had higher NT-proBNP concentrations, lower systolic blood pressure, reported more symptoms and were less frequently treated with a renin-angiotensin system blocker or a beta-blocker than outpatients. The rate (per 100 person-years [PY]) of the primary outcome was higher in hospitalized patients (placebo group=38.3/100 PY) than in outpatients (23.1/100 PY); adjusted hazard ratio (HR) 1.21 (95%CI 1.12, 1.31). The effect of omecamtiv mecarbil versus placebo on the primary outcome was similar in hospitalized patients (HR 0.89, 95%CI 0.78, 1.01) and outpatients (HR 0.94, 95%CI 0.86, 1.02) (interaction P=0.51). CONCLUSION: Hospitalized HFrEF patients had a higher rate of the primary outcome than outpatients. Omecamtiv mecarbil reduced the risk of the primary outcome both when initiated in hospitalized patients and in outpatients.

• Item Type: Articles
• Status: In Press
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Docherty, Dr Kieran and McMurray, Professor John
• Authors: Docherty, K. F., McMurray, J. J.V., Diaz, R., Felker, G. M., Metra, M., Solomon, S. D., Adams, K. F., Böhm, M., Brinkley, D. M., Echeverria, L. E., Goudev, A. R., Howlett, J. G., Lund, M., Ponikowski, P., Yilmaz, M. B., Zannad, F., Claggett, B. L., Miao, Z. M., Abbasi, S. A., Divanji, P., Heitner, S. B., Kupfer, S., Malik, F. I., and Teerlink, J. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Cardiac Failure
• Publisher: Elsevier
• ISSN: 1071-9164
• ISSN (Online): 1532-8414
• Published Online: 07 September 2023
• Copyright Holders: Copyright © 2023 The Author(s).
• First Published: First published in Journal of Cardiac Failure 2023
• Publisher Policy: Reproduced under a Creative Commons license