The applicability of vericiguat therapy in a real-world cohort of hospitalised patients with heart failure with reduced ejection fraction

Introduction

Worsening heart failure (WHF) represents a key challenge in everyday practice with high risk of adverse events, hence adequate and early intervention is of importance among these patients (pts). According to the 2021 European Society of Cardiology Heart Failure (HF) Guidelines, vericiguat, an oral soluble guanylate cyclase stimulator may be considered in pts with HF with reduced ejection fraction (HFrEF) in New York Heart Association (NYHA) class II-IV who have had WHF events despite optimised guideline-directed medical therapy (GDMT), based on the results of the VICTORIA trial.

Aim

to assess the potential eligibility for vericiguat therapy in a real-world, HFrEF pt population hospitalised for HF, according to the randomisation criteria of the VICTORIA trial.

Patients and methods: We retrospectively analysed the data of a consecutive HFrEF pt cohort hospitalised for WHF at the HF Unit of a tertiary cardiac referral center between 01.05.2021 and 01.10.2024. Data from 416 patients were assessed (male: 75%, age: 62 [51-71] years, coronary artery disease: 44%, diabetes: 37%, atrial fibrillation: 45%, eGFR < 60 mL/min/1.73m2: 55%, LVEF: 25 [20-30] %, eGFR at baseline: 58 [46-74] mL/min/1.73m2, NT-proBNP at baseline: 5774 [2638-10534] pg/mL). At hospital discharge a RASi was applied in 92%, a βB in 85%, an MRA in 95%, an SGLT2i in 63%, TT in 82%and QT in 57%.16% of the pts had cardiac resynchronisation therapy with/without defibrillator and 14% of the pts had implantable cardioverter-defibrillator at discharge. The proportion of pts suitable for vericiguat was examined after the optimisation of GDMT. Theoretical eligibility for vericiguat therapy was based on the main in- and exclusion criteria of the VICTORIA trial (NYHA II-IV functional class, left ventricular ejection fraction [LVEF] < 45%, evidence of WHF, NT-proBNP ≥ 1000 pg/mL in sinus rhythm or ≥ 1600 pg/mL in atrial fibrillation, systolic blood pressure [SBP] ≥ 100 mm Hg, estimated glomerular filtration rate [eGFR] ≥ 15 mL/min/1.73 m2).

Results

100% of the pts would have been candidates for vericiguat therapy based on the NYHA functional class, evidence of WHF, and LVEF values. 89% of the cohort would have been eligible for vericiguat based on the NT-proBNP level, 86% based on SBP and 99% based on the eGFR criterion. The concomitant utilisation of all six parameters resulted in the potential application of vericiguat in 74% of pts.

Conclusions

According to our single centre observational, retrospective analysis, significant amount of real-world HFrEF pts would potentially meet the eligibility criteria of the VICTORIA trial, supporting the applicability of vericiguat in routine clinical practice among high-risk pts with WHF. Treatment with vericiguat may be an important, new possibility for the management of HF, besides the use of the four foundational pillars of the HFrEF pharmacotherapy.