VERISEC (n=835, 41 Spanish centres) confirms vericiguat's real-world benefit in HFrEF after recent decompensation. Over 12 months on top of >90% SGLT2i / >85% RAASi / ~80% MRA / 91% beta-blocker background, NT-proBNP fell from 3,532 to 2,292 pg/mL (p<0.001), LVEF rose from 30.3% to 35.4%, NYHA class improved, and HF decompensations requiring IV diuretics halved (1.34 → 0.65 per year). 13.4% discontinued, mostly for symptomatic hypotension; higher baseline NT-proBNP predicted discontinuation.
To evaluate the effectiveness and safety of vericiguat in patients with heart failure and reduced ejection fraction (HFrEF) following recent decompensation in routine clinical practice in Spain.
VERISEC is a prospective, multicenter registry of 835 consecutive patients initiating vericiguat at 41 centers in Spain. Functional class, biochemical markers, ventricular function, and clinical events were analyzed during 1-year follow-up.
Patients (age 71.3 years [SD 11.2], 78.9% male) received highly optimized baseline therapy: 91.5% SGLT2i, 90.7% beta-blockers, 85.4% RAASi, and 79.8% MRAs. Quadruple therapy remained stable (61.7% baseline to 63.0% at 12 months; p=0.526). At 1-year follow-up, significant improvements were observed: NT-proBNP decreased from 3,532 to 2,292 pg/mL (p<0.001) and LVEF increased from 30.3% to 35.4% (p<0.001). NYHA class improved, with class II patients increasing from 55.6% to 62.2% (p<0.001). Mean HF decompensations requiring intravenous diuretics decreased from 1.34/year pre-treatment to 0.65/year during follow-up (≈51% reduction). Non-HF cardiovascular hospitalizations decreased from 0.98 to 0.39 per year. Vericiguat was discontinued in 13.4% of patients, primarily due to symptomatic hypotension (49.4% of discontinuations). Higher baseline NT-proBNP independently predicted discontinuation (OR 1.06 per 1,000-pg/mL increase; 95% CI 1.03–1.08; p<0.001).
In a large real-world Spanish cohort initiating vericiguat after HF decompensation, treatment was associated with improved biomarkers, LV function and functional class, and a halving of HF decompensations — confirming and extending the VICTORIA trial in routine practice.
