Low-Dose Vericiguat in Heart Failure With Reduced Ejection Fraction: A Case Report

Vericiguat is used as an adjunct therapy for patients with heart failure with reduced ejection fraction (HFrEF). Despite its availability in clinical practice, it remains underutilized among eligible patients. This case report describes the clinical benefit of low-dose vericiguat as an add-on therapy in a patient with worsening symptoms due to decompensated HFrEF. A 78-year-old man with HFrEF secondary to ischemic cardiomyopathy experienced recurrent decompensation despite maximally tolerated guideline-directed medical therapy. Vericiguat was initiated at 2.5 mg daily and was not up-titrated due to concerns regarding borderline low blood pressure and worsening renal function. Following treatment initiation, the patient demonstrated symptomatic improvement, with a New York Heart Association (NYHA) functional class improvement from III to I, an increase in left ventricular ejection fraction, and a reduction in heart failure-related hospital admissions during follow-up. Renal function remained stable, and no adverse effects, including hypotension or electrolyte abnormalities, were observed. Despite advances in guideline-directed therapy, outcomes remain suboptimal for many patients with HFrEF. This case highlights the potential clinical benefit of low-dose vericiguat as a safe and effective adjunct therapy, with improvement in functional status and reduced hospitalization burden without compromising renal function. However, these observations may also reflect other contributing factors, and causality cannot be established. Further studies are needed to better define the long-term safety and efficacy of lower-dose vericiguat in broader patient populations.