GALACTIC-HF: Benefit of omecamtiv mecarbil strongest at lowe
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The treatment effect of omecamtiv mecarbil in patients with HF rose as left ventricular ejection fraction declined, according to new data from the GALACTIC-HF trial presented at the American College of Cardiology Scientific Session.

In GALACTIC-HF (n=8,256), the cardiac myosin activator, omecamtiv mecarbil, significantly reduced the primary composite endpoint (PCE) of time-to-first heart failure event or cardiovascular death in patients with heart failure and reduced ejection fraction (EF less than 35%).

This study aimed to evaluate the influence of baseline EF on the therapeutic effect of omecamtiv mecarbil. Outcomes in patients treated with omecamtiv mecarbil were compared to placebo according to EF.

Results:
-- The risk of the PCE in the placebo group was nearly 1.8-fold greater in the lowest (EF less than 22%) compared to the highest (EF more than 33%) EF quartile.

-- Amongst the pre-specified subgroups, EF was the strongest modifier of the treatment effect of omecamtiv mecarbil on the PCE.

-- Patients receiving omecamtiv mecarbil had a progressively greater relative and absolute treatment effect as baseline EF decreased with a 17% relative risk reduction for the PCE in patients with baseline EF less than 22% compared to patients with EF more than 33%.

-- The absolute reduction in the PCE increased with decreasing EF (EF less than 22%: absolute risk reduction, 7.4 events per 100 patient-years; number-needed-to-treat for 3 years = 11.8), compared to no reduction in the highest EF quartile.

Conclusively, in HFrEF patients, omecamtiv mecarbil produced greater therapeutic benefit as baseline EF decreased. These findings are consistent with the drug’s mechanism of selectively improving systolic function and presents an important opportunity to improve the outcomes in a group of patients at greatest risk.

Source: https://www.jacc.org/doi/10.1016/j.jacc.2021.04.065
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