Safety and efficacy of Vericiguat 5mg initiation in combination with guideline-directed medical therapy in the treatment of Heart failure with reduced ejection fraction
Abstract
Despite advancements in guideline-directed medical therapy (GDMT), residual risk persists in heart failure with reduced ejection fraction (HFrEF)1. Vericiguat, a soluble guanylate cyclase stimulator, improves outcomes2,3 but raises safety concerns during dose up-titration, particularly in understudied Asian populations4.
To evaluate the safety and efficacy of initiating vericiguat at 5mg and up-titrating to 10mg in Chinese HFrEF patients receiving optimized GDMT, focusing on hemodynamic tolerance, biomarker changes, and echocardiographic outcomes.
The study was a single-center, prospective, single-arm, self-controlled cohort of 140 Chinese patients with HFrEF ) (LVEF <45%, NYHA II-IV) receiving optimized GDMT. 7 patients were excluded: one was died of sudden cardiac death after 1 month, two were self-withdrawal due to dizzy, two were refused to continue medication for personal reasons and 2 were discontinued due to difficulty going to the hospital. After 4-week GDMT stabilization (ARNI: 88%, SGLT2i: 92%, beta-blockers: 96%, MRA: 93%), vericiguat was initiated at 5mg for the else 133 patients with up-titration to 10mg at Day 14 if tolerated. Serial assessments included hemodynamics, biomarkers (BNP), and echocardiography at baseline, Week 12, and Week 20.
Of 133 patients completing baseline assessment (mean age 61.5±14.2, 75% male, LVEF 34.8±8.5%) (Table 1), 98.5% (131/133) successfully up-titrated to vericiguat 10mg.
Key findings:
Safety: No significant hypotension (Day 1…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 140 participants or records.
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