Vericiguat Therapy for Heart Failure with Reduced Ejection Fraction

Patient Selection and Indication

• The American College of Cardiology recommends vericiguat for patients with left ventricular ejection fraction (LVEF) <45% and New York Heart Association (NYHA) class II-IV symptoms, who have had a recent heart failure worsening, as evidenced by hospitalization within 6 months or receipt of IV diuretics without hospitalization, and have elevated natriuretic peptides (BNP ≥300 pg/mL or NT-proBNP ≥1000 pg/mL in sinus rhythm) 1

Contraindications and Safety Considerations

• The American College of Cardiology advises against the use of vericiguat in patients with systolic blood pressure <100 mm Hg, severe renal impairment (eGFR <15 mL/min/1.73m²), or concomitant use with long-acting nitrates 1

Clinical Efficacy

• The American College of Cardiology notes that vericiguat reduces the primary outcome of cardiovascular death or heart failure hospitalization by 10% compared to placebo (HR 0.90, p=0.019), with a number needed to treat of approximately 33 patients to prevent one primary outcome event 1

Place in Therapy

• The European Society of Cardiology and the American College of Cardiology recommend considering vericiguat for patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal treatment with foundational therapies, including ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor 1, 2
• The American Heart Association, American College of Cardiology, and Heart Failure Society of America give vericiguat a Class 2b recommendation for patients with HFrEF who have had a recent hospitalization or IV diuretic treatment 1