Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

How effective are climate protests at swaying policy — and what could make a difference?

Why people take to the streets to march against global heating is relatively well documented. But it’s unclear why certain tactics work better than others in reaching the public and policymakers

Contesting Actually Existing Austerity

The paper considers what it means to contest austerity and what political contestation of austerity says about how austerity as a political process should be conceived. It does so through separating a narrow view of austerity as fiscal consolidation from actually existing austerity as a broader political economic process ongoing in different ways in different countries. Through a case study of crisis, austerity and contestation as it relates to housing in Spain, the paper argues that to contest actually existing austerity it is necessary to contest both the wealth and power of the actors that have gained from austerity, not least finance capital. Through bank bailouts and the creation of a bad bank, the reforms demanded by the troika have opened up Spanish housing to direct wealth extraction by global finance capital whilst half a million households have been evicted and hundreds of thousands live with insurmountable debt. The Plataforma de Afectados por la Hipoteca (PAH, Platform for the Mortgage-Affected) has contested austerity in Spanish housing by contesting finance capital through civil disobedience whilst campaigning for anti-austerity reforms to housing and mortgage legislation, aiming to limit how housing can be a sphere of wealth extraction for finance capital