Efficacy of early initiation of vericiguat in acute heart failure: a prospective study

Abstract Background Vericiguat has been approved for use in patients with chronic heart failure (HF) who have had a recent worsening HF event in addition to quadruple guideline-directed medical therapy (GDMT). However, the efficacy of vericiguat in patients with GDMT intolerance or new-onset heart failure is unknown. Methods As a post hoc analysis of a real-world prospective cohort study, patients with acute heart failure diagnosed with left ventricular ejection fraction of 45% or lower were enrolled. Patients were non-randomized into the vericiguat and non-vericiguat groups based on whether or not vericiguat treatment was initiated at discharge. The primary endpoint of the study was the time to first occurrence of worsening HF events within 180-days. Results In both pre- and post- propensity score matching cohorts, early initiation of vericiguat therapy was associated with a significantly reduced risk of worsening heart failure, with hazard ratio (HR) of 0.479 (95%CI0.299-0.768, p=0.003); and 0.501, (95%CI0.283-0.888, p=0.020), respectively. A greater proportion of patients with vericiguat achieved NYHA cardiac class I (54.2% vs 22.4%), but there was no statistically significant difference between the two groups in terms of improvement in echocardiographic parameters at the endpoint. In the subgroup analysis, vericiguat therapy remained beneficial for patients who were unable to tolerate quadruple GDMT and for those with new-onset heart failure. Conclusions Vericiguat should be initiated as early as possible during the progression of heart failure, provided there are no contraindications, irrespective of the patient’s ability to tolerate quadruple GDMT. Vericiguat may represent a novel treatment option for patients with GDMT intolerance.