Use of vericiguat: real-world outcomes and insights from the VERITA registry

Abstract Introduction After the VICTORIA study, vericiguat, a guanylate cyclase-stimulating drug, was established as a new pillar of heart failure with reduce ejection fraction (HFrEF) after a heart failure (HF) decompensation. However, its evidence in real life is still limited. Purpose To evaluate the use of vericiguat and assess its impact on functional class, quality of life, HF drugs titration, side effects and morbimortality in a real-life cohort. Methods The VERITA study (use of vericiguat in patient with HFrEF in real life) is a single center, prospective registry that included patients with one year follow-up, from DEC 2022 to FEB 2024. Baseline VERITA data were compared with VICTORIA. Vericiguat impact was evaluated through NYHA functional class, quality of life questionnaires, six-minutes test, HF titration drugs, HF admission and mortality. Results A total of 103 patients were included. The mean age was 71.3 years, 27.2% were women. VERITA patients were older, had more comorbidities, worse functional class, were on better optimized HF treatment and lower cardiac biomarkers compared to VICTORIA trial (Figure 1). At baseline, patients were mainly on NYHA III (61.2%). After vericiguat, a quickly significant improvement in the functional class (p0.001) was observed and maintained until the end of the follow-up. We observed an improvement in the EuroQol questionnaire (p=0.010), visual analogue scale (p0.001) and Kansas City questionnaire (p=0.027). No differences were found in the six-minute walk test. After starting vericiguat, an improvement in angiotensin Receptor–Neprilysin Inhibitor titration (p0.001), a trend towards better mineralocorticoid receptor antagonist titration (p=0.120) and a reduction on loop diuretics use were achieved during follow up (p0,001) (Figure 2). No significant changes were noted in renal function, hemoglobin levels or cardiac biomarkers during follow-up. Maximum vericiguat dose was achieved in 76.7%. The main side effect was asymptomatic hypotension (14.6%). Twelve patients discontinued vericiguat, seven for symptomatic hypotension (6.8%), three due to cardiac transplant (2.9%) and two due to non-cardiovascular reasons (1.9%). A significant reduction of HF admissions was observed (the HF admission index before vericiguat was 1.9 ± 1.3 and 0.60 ± 0.98 after, p0.001). A recent HF decompensation was present on 36 patients (35%). At baseline these patients had higher rates body mass index (BMI), hypertension and atrial fibrillation, worse renal function, elevated cardiac biomarkers, greater use of levosimendan and higher diuretic dose. During follow-up, seven patients died, two of them of cardiovascular cause. Conclusions Despite using vericiguat in a worse HF scenario than in the VICTORIA trial, in the VERITA study after a higher follow-up, vericiguat seems to reduce HF admissions, improve functional class, quality of life questionnaires, as well as achieve better HF drug optimization in a real-life cohort.VERITA characteristics vs VICTORIA NYHA class and HF drugs titration