Identifying the patient with heart failure to be treated with vericiguat

Abstract

The pathophysiology of heart failure with reduced ejection fraction (HFrEF) is a complex process in which a number of neurohormonal systems are involved. Targeting only some of these systems, but not all, translates into a partial benefit of HF treatment. The nitric oxide-soluble guanylate cyclase (sGC)-cGMP pathway is impaired in HF, leading to cardiac, vascular and renal disturbances. Vericiguat is a once-daily oral stimulator of sGC that restores this system. No other disease-modifying HF drugs act on this system. Despite guidelines recommendations, a substantial proportion of patients are not taking all recommended drugs or when taking them, they do so at low doses, limiting their potential benefits. In this context, treatment should be optimized considering different parameters, such as blood pressure, heart rate, renal function, or potassium, as they may interfere with their implementation at the recommended doses. The VICTORIA trial showed that adding vericiguat to standard therapy in patients with HFrEF significantly reduced the risk of cardiovascular death or HF hospitalization by 10% (NNT 24). Furthermore, vericiguat does not interfere with heart rate, renal function or potassium, making it particularly useful for improving the prognosis of patients with HFrEF in specific settings and clinical profiles.

Keywords:

• Beta blockers
• heart failure
• Ivabradine
• mineralocorticoid receptor
• angiotensin receptor–neprilysin inhibitor
• renin angiotensin system
• sodium–glucose co‐transporter 2 inhibitor
• vericiguat

Transparency

Declaration of funding

Writing and editorial assistance was provided by Content Ed Net (Madrid, Spain) with funding from Bayer Hispania.

Declaration of financial/other relationships

CE has received honoraria as a speaker from Astra-Zeneca, Novartis, Boehringer Ingelheim, Vifor Pharma, Rovi and Bayer. AEF has received honoraria as a speaker from Novartis, Boehringer Ingelheim, Vifor Pharma, Fresenius Krabi and Bayer. He has received research grants from Novartis and Boehringer Ingelheim. ARM has received honoraria for lectures from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Janssen, MSD, Novartis and Rovi; participation in advisory boards from Bayer, Janssen, MSD and Novartis; support for attending meetings from Bayer, Boehringer-Ingelheim, Janssen and Novartis. SM has received honoraria for lectures from Boehringer-Ingelheim Lilly, Rovi, Novartis and Astra-Zeneca; participation in advisory boards from Bayer and Boehringer-Ingelheim; support for attending meetings from Boehringer-Ingelheim, Novartis, Vifor, Abbott and Alnylam. JGC has received honoraria for lectures from Abbott, Pfizer, Alnylam, Boehringer-Ingelheim, Zoll, Rovi and Astra-Zeneca; participation in advisory boards from Abbott, Chiesi, Pfizer, Alnylam, Novartis, Bayer and Astra-Zeneca; support for attending meetings from Abbott, Astra-Zeneca, Zoll and Alnylam. JRG declares no conflict of interest. JN reports personal fees from Astra Zeneca, Novartis, Boehringer-Ingelheim, Eli Lilly, Rovi, NovoNordisk, Vifor Pharma and Bayer. AGF has received honoraria for lectures from Astra-Zeneca, Boehringer-Ingelheim, Rovi, Vifor Pharma, Lilly and Novartis; participation in advisory boards from Bayer, Boehringer-Ingelheim, Astra-Zeneca and Novartis; and support for attending meetings from Pfizer, Bayer, Boehringer-Ingelheim, Astra-Zeneca, Boehringer-Ingelheim, Rovi and Novartis. JLBP has received support from Bayer, Rovi, Pfizer, Boehringer Ingelheim, Lilly, AstraZeneca and Novartis for research projects, lectures and/or participation in advisory boards. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None.