Early clinical experience with vericiguat after acute decompensated heart failure in elderly patients with HFrEF: a prospective observational study

Vericiguat has demonstrated clinical benefit in patients with heart failure with reduced ejection fraction (HFrEF), particularly in those at high risk of recurrent heart failure events. However, evidence regarding its early use in elderly patients following hospitalization for acute decompensated HF (ADHF) remains limited. In this prospective single-center case series, 143 consecutive patients aged > 70 years hospitalized for ADHF with HFrEF were enrolled and vericiguat was administrated. Clinical evaluations, left ventricular ejection fraction (LVEF), six-minute walk test (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ), and laboratory parameters were assessed at baseline and after 4 weeks. After 4 weeks of treatment with vericiguat, 44.8% of patients were in NYHA class II and 55.2% in NYHA class III, no patients were in NYHA class IV (p < 0.001); LVEF improved from 34 ± 4.7% to 46.8 ± 7.5% (p < 0.0001); exercise capacity increased significantly (p < 0.001), while a significant decrease in MLHF-Q, NT-proBNP levels and hsCRP was observed (p < 0.001). No symptomatic hypotension, syncope or relevant deterioration in renal function or electrolytes occurred during the observation period. In this single-arm cohort of older patients with HFrEF recently stabilized after ADHF, initiation of vericiguat was feasible and coincided with substantial short-term changes in functional status, LVEF, and circulating biomarkers, without major safety signals during 4 weeks of observation. Given the absence of a control group, these changes cannot be attributed to vericiguat and may reflect, at least in part, recovery from the acute event, decongestion, optimization of background therapy, learning effects, and regression to the mean. These findings should therefore be considered descriptive and hypothesis-generating and require confirmation in controlled studies.