Cardiology Letters 2022, 31(1):29-34

Vericiguat - new drug in heart failure treatment and possibilities of its clinical use

Lesný P

Kardiologická klinika Lekárská fakulta Univerzita Komenského a Národného ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

Hospitalization for worsening of heart failure is one of the most important negative prognostic factors in heart failure (HF) patients. Vericiguat, a soluble guanylate cyclase stimulator, decreases hospitalizations for HF and cardiovascular mortality in patients with worsening heart failure with reduced ejection fraction (HFrEF). The European Society of Cardiology recommends considering prescription of vericiguat in patients with worsening HFrEF despite optimal medical treatment. Reduction of the primary outcome in the VICTORIA study seems less significant than in studies with sacubitril/valsartan and dapagliflozin. However, vericiguat was tested in patients with significantly higher risk of events during a shorter follow-up. Absolute reduction of HF hospitalizations and cardiovascular mortality was comparable to absolute risk reduction in large studies with sacubitril/valsartan or dapagliflozin. Vericiguat preserved its mortality and morbidity benefit in patients with NT-proBNP < 8000 ng/l. Vericiguat does not affect either heart rate or potassium level and it can be administered to patients with significantly reduced renal functions. The main target population of perspective use of vericiguat are patients with HF hospitalization, soon after their clinical stabilization. Vericiguat can be beneficial in patients with markedly reduced renal functions with estimated glomerular filtration rate ≥ 15 ml/min/1.73 m2, as well as in patients with hyperkalemia or bradycardia, where reduction or discontinuation of some of the cornerstone drugs for HFrEF is necessary (renin-angiotensin-aldosterone system blockers, mineralocorticoid receptor antagonists or beta-blockers).

Keywords: heart failure; worsening of heart failure; vericiguat; treatment

Published: January 1, 2022  Show citation