Prospective multicenter registry (VERISEC) of 835 consecutive patients with HFrEF after recent decompensation initiating vericiguat at 41 Spanish centres (mean age 71.3 years, 78.9% male). Baseline therapy was highly optimised: 91.5% SGLT2i, 90.7% beta-blockers, 85.4% RAAS inhibitors, 79.8% MRAs; quadruple therapy was 61.7-63.0% throughout follow-up. At 1 year, NT-proBNP fell from 3,532 to 2,292 pg/mL (p<0.001), LVEF rose from 30.3% to 35.4% (p<0.001), and NYHA class improved. HF decompensations requiring IV diuretics halved (1.34 → 0.65/year); non-HF cardiovascular hospitalisations fell from 0.98 to 0.39/year. Vericiguat was discontinued in 13.4%, mostly for symptomatic hypotension (49.4%); higher baseline NT-proBNP predicted discontinuation (OR 1.06 per 1,000 pg/mL). The real-world data confirm clinical utility and safety of vericiguat on top of quadruple therapy.
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 3532.0 (IQR: 1689.3-6974.5) to 2291.5 pg/mL (IQR: 1063.0-5076.3; p<0.001) and LVEF increased from 30.3% (SD: 7.6) to 35.4% (SD: 11.1; 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 (SD: 1.1) in the preceding year to 0.65 (SD: 1.3) during follow-up. Non-HF cardiovascular hospitalizations decreased from 0.98 (SD: 1.4) to 0.39 (SD: 1.0). Vericiguat was discontinued in 13.4% of patients, primarily due to symptomatic hypotension (49.4%). Higher baseline NT-proBNP (per 1000-pg/mL increase) independently predicted discontinuation (OR: 1.06; 95% CI: 1.03-1.08; p<0.001).
Vericiguat added to optimized quadruple therapy was associated with reverse remodeling, reduced NT-proBNP, improved functional class, and a numerical reduction in HF-related events in real-world HFrEF patients. These findings confirm the clinical utility and safety of vericiguat in routine practice.
