Vericiguat in Decompensated Cardiac Failure: Clinical Insights on Addition to Guidelines-Derived Medical Therapy

Abstract

Objective:  To assess the efficacy of vericiguat compared to placebo in patients with decompensated heart failure, focusing on key outcomes such as hospitalisation rates, cardiovascular death, and side effects like gastrointestinal disturbances and hypotension.

Methodology: A total of 130 patients were enrolled in a randomised controlled trial conducted at the Armed Forces Institute of Cardiology, Rawalpindi, from January 2026 to April 2026. Participants were randomly assigned to receive either vericiguat (n = 64) or placebo (n = 66). The primary outcomes were hospitalisation, cardiovascular death, and side effects, which were assessed through chi-square tests, t-tests, and descriptive statistics.

Results: The study demonstrated no statistically significant differences between the vericiguat and placebo groups. Heart failure hospitalisation occurred in 60.94% (n = 39) of the vericiguat group compared with 45.45% (n = 30) in the placebo group (p = 0.111). Cardiovascular death was observed in 46.88% (n = 30) of patients receiving vericiguat versus 59.09% (n = 39) in the placebo group (p = 0.223). Gastrointestinal disturbances were reported in 59.38% (n = 38) of the vericiguat group and 56.06% (n = 37) of the placebo group (p = 0.838), while hypotension occurred in 51.56% (n = 33) and 56.06% (n = 37), respectively (p = 0.735).

Conclusion: This randomised controlled trial compared vericiguat with placebo in heart failure with reduced ejection fraction, assessing hospitalisation, cardiovascular mortality, and safety outcomes. Vericiguat showed a numerical reduction in heart failure hospitalisation and a favourable trend in the composite outcome and cardiovascular death, but none of these differences were statistically significant.

Keywords: Cardiovascular Death, Heart Failure, Hospitalisation, Side Effects, Vericiguat