Differential rates of guideline-directed medical therapy modification in C-MIC and control patients: results from the C-MIC II trial.
Marat Fudim, Tamara Kovacevic-Preradovic, Dragana N Kosevic et al.
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In 30 seconds
This analysis of the multicentre, randomised C-MIC II trial examined whether changes in background heart failure medication influenced outcomes in ambulatory patients with chronic non-ischaemic HFrEF receiving guideline-directed therapy. Among 65 patients, medication adjustments occurred in 44% of the C-MIC group and 33% of controls (P = .390). Medication intensity decreased with C-MIC and increased in controls, while C-MIC-associated improvements in LVEF, KCCQ-OSS and 6-minute walk distance were consistent regardless of baseline SGLT2 inhibitor use. The authors concluded that benefits were not explained by background pharmacologic intensification.
Key findings
- GDMT adjustments occurred in 44% of C-MIC patients and 33% of controls (P = .390).
- GDMT intensity decreased in the C-MIC group (Δ -0.16) and increased in controls (Δ + 0.36; P = .100).
- C-MIC improved LVEF by +6% with baseline SGLT2i use and +4% without; KCCQ-OSS and 6MWD also improved in both subgroups.
Why it matters
Changes in background therapy can complicate interpretation of heart failure trial outcomes. In this analysis, medication intensity did not increase more in the C-MIC group, and improvements across functional, symptom and cardiac measures were seen with or without baseline SGLT2 inhibitor use. This supports the interpretation that the observed benefits were not simply attributable to greater pharmacologic intensification.
What to keep in mind
The analysis included 65 patients, and comparisons of medication changes were not statistically significant. The abstract does not report whether the subgroup analyses were powered to detect differences.