In This Article
- The novel agent vericiguat is a promising treatment for recently decompensated heart failure with reduced ejection fraction (HFrEF) patients
- The VICTORIA trial shows the drug lowers the risk of heart failure hospitalization in HFrEF patients and is the first to include HFrEF patients
- Significant reduction in heart failure hospitalization risk in any contemporary trials should be considered notable, says Jim Januzzi, MD, of Massachusetts General Hospital
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The recent VICTORIA trial shows that the novel oral agent vericiguat, a soluble guanylate cyclase stimulator, reduced mortality and hospitalization among recently decompensated heart failure with reduced ejection fraction (HFrEF) patients. Prior to this trial, patients with recent heart failure hospitalization for decompensation were excluded from trials that showed benefit. This population with longer disease duration and narrow options for treatment now has a promising treatment option.
Once-daily doses of the drug reduced the death rate from cardiovascular causes or the rate of first hospitalization for heart failure by 10% compared to placebo. These results show a promising outlook, as no other therapies have lowered the risk of heart failure hospitalization in HFrEF patients.
The data from the trial are also the first to indicate a singular intervention may lower cardiovascular events after hospitalization or the need for IV diuretics.
Jim Januzzi, MD, director of the Dennis and Marilyn Barry Fellowship in Cardiology Research at Massachusetts General Hospital, commented in MedPage Today that any significant reduction in heart failure hospitalization risk in a contemporary heart failure trail should be taken seriously, given that our armamentarium consists of drugs that lower mortality.
Some critiques of the study include that only 15% of participants received sacubitril-valsartan in their concomitant guideline-based medical therapy. However, Dr. Januzzi says that the level of sacubitril-valsartan prescribing mimics real life.
The VICTORIA trial criteria likely apply to one in four heart failure patients. However, notably, those with systolic blood pressure under 100 mm Hg are excluded. Limitations of the trial sample also included less than 5% representation of Black patients.
Increased anemia with the drug, prespecified subgroup analyses trending in the wrong direction for patients in the top quartile for NT-proBNP level and potential cost are also concerns that researchers are continuing to investigate.
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