Efficacy and Safety of Vericiguat in a Real-life Population with Heart Failure after 1 Year of Treatment: The VERITA Study

Aim: To determine the efficacy and safety of vericiguat in a real-world cohort of patients with heart failure (HF) with reduced ejection fraction in Spain. Methods: A prospective observational study of HF with reduced ejection fraction patients with a recent episode of worsening HF, requiring IV therapy, and who initiated vericiguat in a HF outpatient clinic was carried out. Of the 103 patients included, 28 (27.2%) were women. Results: At baseline, the mean age was 71.3 ± 9.4 years, the median ejection fraction was 34% (interquartile range; IQR 28-39%) and N-terminal pro-B-type natriuretic peptide was 2,034 pg/ml (IQR 910-3,372 pg/ml). Regarding HF treatments, 99% of patients were taking β-blockers, 97.1% sodium-glucose cotransporter 2 inhibitors, 96.1% sacubitril-valsartan, 91.2% mineralocorticoid receptor antagonists and 93.2% loop diuretics. After 1 year of treatment with vericiguat, New York Heart Association functional class improved from 36.9 and 63.1% in classes II and III to 72.1 and 16.3%, respectively, as did the visual analogue scale score, from 60 (50-75) to 70 (50-85; both p<0.001). N-terminal pro-B-type natriuretic peptide levels decreased from 2,034 pg/ml (IQR 910-3,372 pg/ml) to 1,282 pg/ml (IQR 562-3,303 pg/ml; p=0.034). The dosage of angiotensin receptor-neprilysin inhibitors increased significantly (p<0.001), and the dose of furosemide was reduced (p=0.032). The number of HF-related hospitalisations/emergency department visits within the previous year was 1.9 ± 1.3, decreasing to 0.55 ± 0.98 (p<0.001). At study end, 7.8% of patients had died (one-quarter of HF). Only 11.7% of patients discontinued vericiguat (6.8% owing to hypotension), and 77.7% achieved the target dose of 10 mg. Conclusion: In clinical practice, treatment with vericiguat is associated with substantial improvements in functional class and quality of life, reductions in natriuretic peptide levels and clinical events, and a good safety profile.