Key result
Omecamtiv mecarbil consistently reduces HF or CV death across Black and White patients.
Why the study?
Omecamtiv mecarbil improves cardiovascular outcomes in HFrEF, but consistency of drug benefit across race is a key public health topic.
Does omecamtiv mecarbil reduce the composite of HF events or cardiovascular death consistently in Black versus White patients with symptomatic HFrEF?
RCT
Yes
Does omecamtiv mecarbil reduce the composite of HF events or cardiovascular death consistently in Black versus White patients with symptomatic HFrEF?
Omecamtiv mecarbil provides consistent cardiovascular benefits and safety in Black patients with HFrEF compared to White patients.
Supports consistent omecamtiv mecarbil use in Black and White HFrEF patients; confirms efficacy across races in this RCT.
BACKGROUND: Omecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. OBJECTIVES: The purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. METHODS: In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. RESULTS: Black patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro-B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs -0.7 mm Hg, P for interaction = 0.02). CONCLUSIONS: GALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts.
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Lanfear et al. (2023) conducted an RCT in Heart failure with reduced ejection fraction. Omecamtiv mecarbil vs. Placebo was evaluated on Composite of time to first event of heart failure or cardiovascular death (HR 0.83 vs 0.88, p=0.66 for interaction). Omecamtiv mecarbil provided consistent benefits for the primary composite endpoint of heart failure or cardiovascular death in Black versus White patients (HR 0.83 vs 0.88, P-interaction=0.66).
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