Key result
Vericiguat cuts CV death or HF hospitalization ~10% vs. placebo in worsening HFrEF.
Why the study?
Elderly patients with heart failure have unique features that modify therapeutic response, and dedicated evidence regarding vericiguat in frail older adults and those with geriatric syndromes remains limited.
Does vericiguat improve clinical outcomes and maintain an acceptable safety profile in elderly patients with heart failure and reduced ejection fraction?
Does vericiguat improve clinical outcomes and maintain an acceptable safety profile in elderly patients with heart failure and reduced ejection fraction?
Vericiguat provides a complementary therapeutic strategy for elderly patients with worsening HFrEF, demonstrating consistent benefits and acceptable safety, though careful clinical implementation is advised due to frailty and polypharmacy.
Answers are grounded in this paper and cite their sources.
Supports vericiguat in older adults with worsening HFrEF; leaves open dedicated trials in frail elderly.
Elderly patients with heart failure (HF) represent a rapidly growing and highly heterogeneous population marked by multimorbidity, frailty, and polypharmacy. These age-related features profoundly influence the course of HF and modify therapeutic response. Vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, targets the impaired nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) pathway, a central mechanism in vascular dysfunction and maladaptive remodelling. Clinical evidence, primarily from the VICTORIA trial and subsequent studies, supports vericiguat in selected patients with heart failure with reduced ejection fraction (HFrEF), particularly following recent worsening HF despite guideline-directed medical therapy (GDMT). Most of the available evidence derives from HFrEF populations, whereas studies in heart failure with preserved ejection fraction (HFpEF) have not demonstrated significant clinical benefit. In addition, dedicated evidence in frail older adults and in patients with geriatric syndromes remains limited. This review summarises current knowledge on the pharmacological rationale, pharmacokinetics, and pivotal clinical studies of vericiguat, highlighting quantitative results and their implications for clinical implementation in elderly patients with HFrEF and complex clinical profiles.
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Rao et al. (2026) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Vericiguat vs. Placebo was evaluated on Composite of cardiovascular death or first heart failure hospitalization (HR 0.90, 95% CI 0.82-0.98, p=0.02). Vericiguat reduced the composite endpoint of cardiovascular death or heart failure hospitalization compared to placebo in patients with worsening HFrEF, with consistent benefits and acceptable tolerability in older adults.
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