Key result
Vericiguat fails to reduce CV death or HF hospitalization in stable HFrEF without recent worsening.
Why the study?
The authors analyzed results of the VICTOR trial to evaluate vericiguat within the broader field of HFrEF, where anticipating worsening heart failure events remains necessary to improve prognosis.
Does vericiguat reduce cardiovascular death or heart failure hospitalization in stable, ambulatory HFrEF patients without recent worsening heart failure?
Does vericiguat reduce cardiovascular death or heart failure hospitalization in stable, ambulatory HFrEF patients without recent worsening heart failure?
Although vericiguat did not reduce the primary composite endpoint in stable HFrEF patients without recent worsening heart failure, a nominal reduction in cardiovascular mortality suggests it might be considered earlier in the treatment pathway.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Although vericiguat did not improve the primary composite of cardiovascular death or hospitalisation for HF, there were fewer cardiovascular deaths with vericiguat and this translated into fewer all-cause deaths.”
“It's kind of unique in heart failure trials because [cardiovascular] death usually goes hand in hand with heart failure hospitalizations.”
“The disconnect between mortality and HF hospitalizations has not been seen in other trials of HF drugs.”
Should not yet change HFrEF practice; leaves open vericiguat's isolated CV mortality effect.
IntroductionThe VICTOR trial evaluated vericiguat in stable, ambulatory HFrEF patients without recent WHF, but did not reduce the primary composite endpoint of CV death or HF hospitalization. Yet, a significant reduction in CV mortality was observed.Areas coveredWe analyzed the results of the VICTOR trial and put them in the broader field of HFrEF, where anticipating WHF events remains a mandatory task to improve the overall prognosis. We discussed oral diuretic intensification (ODI), that should represent an important aspect to be considered in stable HFrEF patients. Expert opinionOutpatient WHF events are common in well-treated HFrEF patients and in the future HF trials should consider to regularly capture ODI. Although secondary endpoint analyses should be interpreted as nominal, the reduction in CV mortality in the VICTOR trial cannot be explained solely through prevention of HF progression or an effect on neurohormonal activation and hemodynamic stress. While current evidence for vericiguat is largely derived from patients with recent WHF, the findings of VICTOR might provide a rationale for considering vericiguat earlier in the HFrEF treatment pathway, rather than limiting its use exclusively to patients who fail or progress despite quadruple therapy.
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Larroux et al. (2026) conducted a review in Heart Failure with reduced Ejection Fraction (HFrEF). Vericiguat was evaluated on Composite endpoint of CV death or HF hospitalization. Vericiguat did not reduce the primary composite endpoint of CV death or HF hospitalization in stable HFrEF patients without recent worsening heart failure.
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