{"id":"aadc13fa7773","type":"article","url":"https://hartvaat.nl/2026/05/05/mavacamten-in-de-praktijk-zwarte-patienten-krijgen-55-minder-vaak-toegang-atrium/","title":"Mavacamten in de praktijk: zwarte patiënten krijgen 55% minder vaak toegang — atriumfibrilleren voorspelt slechtere uitkomst","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","esc-2026","hypertrofische-cardiomyopathie","slaapapneu","supraventriculaire-tachycardie","vrouwen"],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.045994","source_url":"https://doi.org/10.1161/JAHA.125.045994","authors":["Ayman R Fath","Amro Aglan","Srihari S Naidu","Michael J Mader","Robert J Chilton","Islam Y Elgendy","Martin S Maron","Ethan J Rowin"],"significance":7,"published":"2026-06-27","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"esc-2026","summary_en":"Multicenter observational analysis on TriNetX data (2011-2023) in 15,145 patients with obstructive hypertrophic cardiomyopathy, of whom 509 (3.5%) received mavacamten. After propensity matching (502 mavacamten vs 1,475 weighted controls 1:3), access was sharply stratified: Black patients had 55% lower odds of receiving mavacamten than White patients (OR 0.45; 95% CI 0.33-0.63). Among mavacamten recipients, 4.8% had acute heart failure, 8.3% systolic dysfunction, 10.8% cardiovascular hospitalisation, 6.4% new-onset AF, and 1.4% died. Outcomes were largely similar to controls, except for higher incidence of systolic dysfunction with mavacamten (log-rank p<0.001). Patients with baseline AF (28%) had significantly worse outcomes within the mavacamten group: more acute heart failure (7.8% vs 3.6%), systolic dysfunction (12.8% vs 6.4%), CV hospitalisation (27.7% vs 4.2%), and mortality (5% vs 0%). The equity gap and elevated risk with pre-existing AF are important practice signals.","created":"2026-07-03T10:33:07Z","updated":"2026-08-10T11:07:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter observationele analyse op TriNetX-data (2011-2023) bij 15.145 patiënten met obstructieve hypertrofische cardiomyopathie, waarbij 509 (3,5%) mavacamten kregen. Na propensity-matching (502 mavacamten versus 1.475 gewogen controles 1:3) bleek de toegang sterk gestratificeerd: zwarte patiënten hadden 55% lagere kans op mavacamten dan witte (OR 0,45; 95%-BI 0,33-0,63). Bij mavacamten-gebruikers traden op: 4,8% acuut hartfalen, 8,3% systolische dysfunctie, 10,8% cardiovasculaire opname, 6,4% nieuw AF en 1,4% sterfte. Uitkomsten waren grotendeels gelijk aan controles, behalve een hogere incidentie van systolische dysfunctie bij mavacamten (log-rank p<0,001). Patiënten met baseline AF (28%) hadden binnen de mavacamten-groep significant slechtere uitkomsten: meer acuut hartfalen (7,8% vs 3,6%), systolische dysfunctie (12,8% vs 6,4%), CV-opname (27,7% vs 4,2%) en sterfte (5% vs 0%). De equity-gap én het verhoogde risico bij pre-existent AF zijn belangrijke signalen voor de praktijk.","abstract_original":"BACKGROUND: Mavacamten improves symptoms in obstructive hypertrophic cardiomyopathy, but real-world prescription patterns, safety profile, and the effect of atrial fibrillation (AF) on outcomes remain unclear. METHODS: An observational multicenter analysis using patient-level data from the TriNetX database (2011-2023) compared patients with obstructive hypertrophic cardiomyopathy treated with mavacamten versus those not treated with mavacamten (controls). Multivariable logistic regression identified predictors of mavacamten use. Propensity-score matching was used to reduce confounding bias. Outcomes included acute heart failure, left ventricular systolic dysfunction, cardiovascular hospitalization, new-onset AF, and all-cause mortality. Outcomes were also stratified by AF history. RESULTS: Among 15 145 patients, 509 (3.5%) received mavacamten; 502 matched to 1475 weighted 1:3 controls (equivalent to 502). Black patients were significantly less likely to receive mavacamten compared with White patients (odds ratio, 0.45 [95% CI, 0.33-0.63]). Of the 502 mavacamten recipients, 4.8% experienced acute heart failure, 8.3% experienced systolic dysfunction, 10.8% experienced cardiovascular hospitalization, 6.4% experienced new-onset AF, and 1.4% died. Overall outcomes were similar between both groups except for a higher incidence of systolic dysfunction in mavacamten patients (log-rank P<0.001). Among mavacamten patients, those with baseline AF (28%) had significantly higher rates of acute heart failure (7.8% versus 3.6%; P=0.047), systolic dysfunction (12.8% versus 6.4%; P=0.02), cardiovascular hospitalization (27.7% versus 4.2%; P<0.01), and mortality (5% versus 0%; P<0.01). Older age independently predicted acute heart failure, whereas baseline AF predicted both cardiovascular and all-cause hospitalization. CONCLUSIONS: Black patients have markedly lower access to mavacamten. Preexisting AF was associated with a higher risk of adverse outcomes for patients on mavacamten, highlighting the need for careful monitoring."}