Experience Of Initiating Vericiguat In An Advanced Heart Failure Program

Background

While the safety and efficacy of  vericiguat  are described in clinical trials, data on its real-world application are lacking. This study described the experience of initiating vericiguat therapy at the Advanced Heart Failure Clinic at Georgia Heart Institute.

Methods

A retrospective analysis of the clinical characteristics and  titration  progress for patients receiving vericiguat from Jan 20, 2021, to Mar 15, 2022, was conducted.

Results

Seventeen patients with a mean (standard deviation [SD]) age of 62.6 (12.17) years old were identified with  NYHA  Class II (n = 2), Class III (n = 13), and Class IV (n = 2) symptoms. Among them, 11 patients were male, and 5 patients were black. The numbers of patients with the three index events, <3 months after HF hospitalization (HFH), 3-6 months after HFH, and IV  diuretic therapy  without HFH within the prior 3 months, were 7, 7, and 3, respectively. The baseline characteristics of the patients are shown in the table below. At the time of initiating vericiguat, the means (SD) of estimated  glomerular filtration rate  and  left ventricular ejection fraction  were 42.73 (21.33) ml/min/1.73m 2  and 25 (7.61) %, and the median (interquartile range [IQR]) of NT-pro BNP was 5534.5 (724-26,505) pg/ml. During the therapy, three patients received long-acting nitrates with vericiguat concomitantly. Two patients discontinued vericiguat therapy due to hypotension and  gastrointestinal complaints , and two patients deceased. Among the remaining 13 patients currently on vericiguat, the median (IQR) dose of vericiguat was 5 (2.5, 5) mg daily, with two patients achieving the targeting 10 mg. The medium (IQR) duration of vericiguat therapy in these 13 patients was 126 (25-195) days. After reviewing the medical chart, hypotension was identified as the reason for the delayed  dose titration  of vericiguat.

Conclusion

Compared to the VICTORIA trial, patients who received vericiguat in our clinic had more advanced HF with  severe renal impairment . The dose titration of vericiguat was unlikely to be achieved in a timely manner due to the risk of hypotension, which limited the clinical use of vericiguat.