Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction

Abstract

Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided.

Dosing Challenges and Benefits of Vericiguat in a Patient With Decompensated Heart Failure: A Case Report

“…Furthermore, the drug has also been associated with improving the overall quality of life, which was also observed in our patient [6,7]. Subsequent studies to the VICTORIA trial have demonstrated that patients with an NT-proBNP level below 8000 pg/ml experience a reduction in cardiovascular mortality or initial hospitalization for heart failure, suggesting that the treatment is most beneficial for patients with less advanced HFrEF [9,10].…”

Recent Advances across the Spectrum of Heart Failure and Heart Transplant

“…Subsequently, triple neurohormonal blockade and then quadruple therapy have become the standard of care (SoC). To date, several different pathways are successfully targeted with novel drugs [ 1 , 2 ]. Thus, HF specialists went from an era in which disease-modifying therapies were lacking to a new era, where they needed to tailor pharmacologic treatment according to patients’ phenotype.…”

Beyond Medical Therapy—An Update on Heart Failure Devices

“…Additionally, based on clinical profiles, [4] further medications are recommended to improve patients' QoL and functional capacity and reduce hospitalizations, with Vericiguat being the first to enhance an endogenous pathway rather than inhibit it. [5] Despite these remarkable advances, the registry data are not reassuring. First, HF's prevalence is rising worldwide, and not only because of population aging.…”