The hottest research from various peer-reviewed journals – handpicked weekly by the ACC.org Editorial Board led by Kim A. Eagle, MD, MACC.
New Data Highlight Disproportionate Representation of Blacks, Hispanics Among COVID-19 Hospitalizations
"Although in-hospital mortality and major adverse cardiovascular events (MACE) did not differ by race/ethnicity, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations," according to Fatima Rodriguez, MD, MPH, et al. as part of a COVID-19 late-breaking science session at AHA 2020.
The findings, also published in Circulation, are based on an analysis of data on 7,868 patients hospitalized with COVID-19 at 88 U.S. hospitals participating in the America Heart Association COVID-19 Cardiovascular Disease Registry between Jan. 17 and July 22. The primary outcome was in-hospital mortality and secondary outcomes included MACE and COVID-19 cardiorespiratory ordinal severity score. Rodriguez and colleagues used multivariable logistic regression analyses to assess the relationship between race/ethnicity and each outcome adjusting for sociodemographic, clinical and presentation differences.
Of the patients analyzed for the study, Black and Hispanic patients accounted for >50% of the hospitalizations. Specifically, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Researchers noted that Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients also had the highest prevalence of obesity, hypertension and diabetes.
In terms of treatment and presentation symptoms, Black patients had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%), compared with other racial/ethnic groups. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation. Of the 18.4% of patients who died, more than half were Black and Hispanic. Results were similar for MACE, Rodriguez, et al, said.
Based on the findings, the authors suggest that "interventions to reduce disparities in COVID-19 should focus upstream from hospitalization."
Rodriguez F, Solomon N, de Lemos JA, et al. Circulation 2020;Nov 17:[Epub ahead of print].
EPIC-HF and MyROAD Trials Explore HF Patient Tools
Nearly half of heart failure (HF) patients who received a patient engagement and education tool prior to a cardiology clinic visit had a positive change in their medication therapy, according to results of the EPIC-HF trial presented during AHA 2020 and simultaneously published in Circulation.
In EPIC-HF, Larry A. Allen, MD, MHS, FACC, et al., looked at 290 patients with HF with reduced ejection fraction (HFrEF) randomized to receive usual care vs. additional patient engagement and education tools (a three-minute video and a one-page medication checklist) delivered electronically one week, three days and 24 hours prior to a cardiology clinic visit. The median age was 65 years, 29% were female, and the median left ventricular EF was 32%.
Results showed that 30 days after the cardiology clinic visit, nearly half (49%) of the patient tools group had an initiation or intensification of their guideline-directed medical therapy vs. 29.7% in the usual care group. Most changes were increases in the doses of generic HFrEF medications already prescribed, not new medications.
"This approach validates and promotes a culture of collaboration between patients and their doctors and leads to more productive clinic visits with optimized medication prescribing, which can ultimately improve patient outcomes," says Allen.
Allen LA, Venechuk G, McIlvennan CK, et al. Circulation 2020;Nov 17:[Epub ahead of print].
GALACTIC-HF: Omecamtiv Mecarbil and Systolic Heart Failure
Patients with heart failure and a reduced ejection fraction (HFrEF) who received the selective cardiac myosin activator omecamtiv mecarbil had a lower risk of a composite of HF events and cardiovascular death than those who received placebo, according to results from the GALACTIC-HF trial presented at AHA 2020 and simultaneously published in the New England Journal of Medicine.
Researchers randomly assigned 8,256 patients with chronic HFrEF (≤35%) to receive omecamtiv mecarbil (25 mg, 37.5 mg or 50 mg twice daily) or placebo in addition to standard HF therapy. The primary outcome was a composite of a first HF event or cardiovascular-related death.
Of note, participants were predominantly male (79%) and white (78%), with an average age of 66 years and average EF of 27%. In addition, 62% had coronary artery disease; 40% had Type 2 diabetes; 70% had high blood pressure; 36% had chronic kidney disease; and 25% were hospitalized at the time of enrollment. While only 7% of participants self-reported as Black, more Black patients were enrolled in GALACTIC-HF than in any contemporary, international HF trial.
Over a median of 21.8 months, a primary outcome event occurred in 1,523 of 4,120 patients (37.0%) in the omecamtiv mecarbil group vs. 1,607 of 4,112 patients (39.1%) in the placebo group (p=0.03). A total of 808 patients (19.6%) in the omecamtiv mecarbil group died from cardiovascular-related causes vs. 798 patients (19.4%) in the placebo group. Researchers observed no significant difference between the two groups in secondary outcomes, including change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptoms core or frequency of cardiac ischemic and ventricular arrhythmia events.
"These findings support the hypothesis that improving cardiac function by selectively targeting the cardiac sarcomere with omecamtiv mecarbil can improve clinical outcomes," said John R. Teerlink, MD, FACC, and colleagues. However, they noted the "lack of effect on death from either cardiovascular causes or any cause is surprising, given the prior evidence with omecamtiv mecarbil of improvements in left ventricular volumes and function, as well as decreases in heart rate andNT-proBNP."
Looking ahead, Teerlink said "the findings will inform potential future implementation of omecamtiv mecarbil to treat chronic heart failure."
Teerlink JR, Diaz R, Felker GM, et al. N Engl J Med 2020;Nov 13:[Epub ahead of print].
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Novel Agents, Statins
Keywords: ACC Publications, Cardiology Magazine, Child, Preschool, Cholesterol, LDL, Blood Pressure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atenolol, Aged, Ethnic Groups, Ramipril, Cardiovascular Diseases, Coronary Artery Disease, Vitamins, Hospital Mortality, Coronary Vessels, Aspirin, Simvastatin, Mineralocorticoid Receptor Antagonists, Vitamin D, Takotsubo Cardiomyopathy, Secondary Prevention, Incidence, Tomography, Optical Coherence, Diabetes Mellitus, Type 2, Prospective Studies, Myocarditis, remdesivir, Myocardial Infarction, Cardiomyopathies, Naphthyridines
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