Influence of atrial fibrillation on efficacy and safety of omecamtiv mecarbil in heart failure: the GALACTIC-HF trial

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dc.contributor.authorSolomon, Scott D.
dc.contributor.authorClaggett, Brian L.
dc.contributor.authorMiao, Zi Michael
dc.contributor.authorDiaz, Rafael
dc.contributor.authorFelker, G. Michael
dc.contributor.authorMcMurray, John J., V
dc.contributor.authorMetra, Marco
dc.contributor.authorCorbalan, Ramon
dc.contributor.authorFilippatos, Gerasimos
dc.contributor.authorGoudev, Assen R.
dc.contributor.authorMareev, Viatcheslav
dc.contributor.authorSerpytis, Pranas
dc.contributor.authorSuter, Thomas
dc.contributor.authorYilmaz, Mehmet B.
dc.contributor.authorZannad, Faiez
dc.contributor.authorKupfer, Stuart
dc.contributor.authorHeitner, Stephen B.
dc.contributor.authorMalik, Fady, I
dc.contributor.authorTeerlink, John R.
dc.date.accessioned2025-01-20T21:10:40Z
dc.date.available2025-01-20T21:10:40Z
dc.date.issued2022
dc.description.abstractAims In GALACTIC-HF, the cardiac myosin activator omecamtiv mecarbil compared with placebo reduced the risk of heart failure events or cardiovascular death in patients with heart failure with reduced ejection fraction. We explored the influence of atrial fibrillation or flutter (AFF) on the effectiveness of omecamtiv mecarbil. Methods and results GALACTIC-HF enrolled patients with New York Heart Association (NYHA) Class II-IV heart failure, left ventricular ejection fraction <= 35%, and elevated natriuretic peptides. We assessed whether the presence or absence of AFF, a pre-specified subgroup, modified the treatment effect for the primary and secondary outcomes, and additionally explored effect modification in patients who were or were not receiving digoxin. Patients with AFF (n = 2245, 27%) were older, more likely to be randomized as an inpatient, less likely to have a history of ischaemic aetiology or myocardial infarction, had a worse NYHA class, worse quality of life, lower estimated glomerular filtration rate, and higher N-terminal pro-B-type natriuretic peptide. The treatment effect of omecamtiv mecarbil was modified by baseline AFF (interaction P = 0.012), with patients without AFF at baseline deriving greater benefit. The worsening of the treatment effect by baseline AFF was significantly more pronounced in digoxin users than in non-users (interaction P = 0.007); there was minimal evidence of effect modification in those patients not using digoxin (P = 0.47) or in digoxin users not in AFF. Conclusion Patients in AFF at baseline were less likely to benefit from omecamtiv mecarbil than patients without AFF, although the attenuation of the treatment effect was disproportionally concentrated in patients with AFF who were also receiving digoxin. Clinical Trial Registration: NCT02929329
dc.fuente.origenWOS
dc.identifier.doi10.1093/eurheartj/ehac144
dc.identifier.eissn1522-9645
dc.identifier.issn0195-668X
dc.identifier.urihttps://doi.org/10.1093/eurheartj/ehac144
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/93587
dc.identifier.wosidWOS:000772855600001
dc.issue.numero23
dc.language.isoen
dc.pagina.final2220
dc.pagina.inicio2212
dc.revistaEuropean heart journal
dc.rightsacceso restringido
dc.subjectHeart failure
dc.subjectAtrial fibrillation
dc.subjectMyosin activator
dc.subjectDigoxin
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleInfluence of atrial fibrillation on efficacy and safety of omecamtiv mecarbil in heart failure: the GALACTIC-HF trial
dc.typeartículo
dc.volumen43
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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