Renal function and vericiguat in heart failure patients: light at the end of the tunnel!
Abstract
The optimization of guideline-directed heart failure (HF) therapy remains the mainstay to further improve outcomes for patients with HF with reduced ejection fraction (HFrEF).1 New HF drugs have been shown to target various pathways, such as the sodium–glucose co-transporter 2 (SGLT2) inhibitors (dapagliflozin, empagliflozin), the guanylate cyclase stimulator (vericiguat) and the cardiac myosin activator (omecamtiv mecarbil), and have been shown to improve prognosis.2 Renal dysfunction is common in patients with HF, with a greater prevalence in those with more advanced symptoms and associated with a worse outcome.3 Nonetheless, HF patients with severe renal dysfunction have usually been excluded from the major HF randomized trials, making it difficult to be certain of the benefit of HF drugs in this group of patients.3 In HF, the impaired formation of cyclic guanosine monophosphate (cGMP) contributes to endothelial dysfunction and possibly causes myocardial relaxation impairment.4 Vericiguat is an orally available soluble guanylate cyclase (sGC) stimulator that activates the formation of cGMP.4 Based on this concept, the VICTORIA (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) trial was designed and randomized 5050 patients to vericiguat vs. placebo. The trial included patients with more severe HF and reduced ejection fraction (<45%), some of whom were randomized immediately after recovery from acute decompensation. The VICTORIA trial…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 5,050 participants or records.
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