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

The intruders : refugee doctors in Australia

Among the thousands of European refugees who arrived in Australia between 1947 and 1954 as immigrants assisted by the Australian Government were many highly qualified professionals. These included a number of doctors, whose fate is the subject of this book. Misled by information given them in Europe, the majority of these men and women arrived expecting to continue their careers. But, faced with the implacable op position of the Australian Medical Association and the indifference of the authorities, they found it impossible to obtain registration and most were forced to take jobs as hospital orderlies, cleaners, factory hands or labourers. This book examines the factors that led to the situation where, when there was an urgent need for medical practitioners in Australia, these qualified people were denied the opportunity of using their skills. The AMA emerges as the main obstruction in this affair but there is little to be said for the State and Commonwealth governments. The latter in particular, though quick to take advantage of the skills of these doctors in New Guinea and Antarctica, where Australian doctors were reluctant to go, did nothing to assist them to resume their careers in the mainland territories over which it had control. Though eventually most refugee doctors were able to obtain registration in Australia, for some it came too late and the wasted years and loss of skill represented a great deprivation, both to the doctors and to Australian society. This book is an indictment of the short-sightedness of those who could have helped to avoid this waste of talent