Heart failure therapy: the fifth card

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• The 2021 European Society of Cardiology guidelines shift from sequential to a four-drug class approach for heart failure (HF) management.
• This new strategy involves initiating and titrating angiotensin receptor-neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors for patients with reduced ejection fraction (<35%).
• Advantages include rapid initiation, improved tolerability, and earlier reassessment of treatment efficacy.

Purpose of the Study:

• To evaluate the efficacy and safety of vericiguat, a soluble guanylate cyclase activator, in patients with heart failure.
• To assess vericiguat's impact on cardiovascular death and HF hospitalizations in a high-risk population, as demonstrated in the VICTORIA study.
• To investigate vericiguat's role in patients with HF on optimized therapy without recent stabilization events, as explored in the ongoing VICTOR trial.

Main Methods:

• The VICTORIA study assessed vericiguat's effect on a composite outcome of cardiovascular death and HF hospitalization.
• The VICTOR trial is a randomized clinical trial evaluating vericiguat in HF patients receiving optimized therapy.
• These studies involve high-risk populations and patients with specific HF characteristics.

Main Results:

• The VICTORIA study demonstrated that vericiguat significantly reduced the composite outcome of cardiovascular death and first HF hospitalization in a high-risk population.
• Vericiguat's mechanism as a soluble guanylate cyclase activator offers a novel therapeutic pathway for HF management.

Conclusions:

• The updated HF guidelines promote a comprehensive, multi-drug approach for optimal patient management.
• Vericiguat represents a promising therapeutic option for reducing adverse cardiovascular events in specific HF populations.
• Ongoing research, including the VICTOR trial, will further elucidate vericiguat's role in diverse HF patient profiles.