Hypotension and outcomes after vericiguat initiation in patients with heart failure and mildly reduced or preserved ejection fraction
T Suzuki, T Nasu, W Fujimoto, N Kagiyama, Y Shiraishi, S Ishii, T Ijichi, G Nakazawa, T Ikeda, K Kanaoka, S MatsumotoAbstract
Background
Compare to patients with heart failure (HF) and reduced ejection fraction (HFrEF), less is known about the safety of vericiguat in those with HF and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). We evaluated the most relevant adverse event of vericiguat—symptomatic/asymptomatic hypotension—according to left ventricular ejection fraction (LVEF) subtypes.
Methods
In a nationwide, multicenter, retrospective study involving 22 hospitals in Japan (VERIFY-HF), we examined the incidence of symptomatic/asymptomatic hypotension and drug discontinuation within 90 days after initiation of vericiguat, according to LVEF subtypes (HFrEF versus HFmrEF/HFpEF). The association between hypotension and subsequent outcomes was also examined.
Results
Among the 975 patients with HF and available LVEF measurement, the mean age was 70 years, and 28.8% were female. Of them, 40.1% had systolic blood pressure <100 mmHg at baseline. Within 90 days, symptomatic or asymptomatic hypotension was more often observed in HFrEF than in HFmrEF/HFpEF (HFrEF versus HFmrEF/HFpEF: 26.0% versus 17.9%, P<0.01), with asymptomatic hypotension being more common in both LVEF subtypes (18.3% and 13.1%). By contrast, drug discontinuation due to hypotension was uncommon regardless of LVEF (4.3% versus 3.7%, P=0.66). In a time-updated Cox model, patients who experienced asymptomatic or symptomatic hypotension within 90 days had a greater subsequent risk of cardiovascular death or HF hospitalization than those who did not (HR: 1.42 [95% CI: 1.10-1.84], P<0.01) (Figure).
Conclusions
Compared to HFrEF, patients with HFmrEF/HFpEF had a lower risk of hypotension after vericiguat initiation, which was a relevant adverse event associated with worse clinical outcomes.Figure. Subsequent outcomes after the inFor image description, please refer to the figure legend and surrounding text.