Vericiguat in Routine Practice: Insights from a Prospective Real-World Study in Chinese Population

Heart failure (HF) with reduced ejection fraction (HFrEF) remains a progressive condition with unacceptably high residual risk despite contemporary therapeutic approaches based on so-called four pillars.” Even with angiotensin receptor-neprilysin inhibitors (ARNIs), β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, many patients experience recurrent hospitalizations and high cardiovascular (CV) death [1‒3]. Among the latest additions, vericiguat – a soluble guanylate cyclase (sGC) stimulator – targets the impaired nitric oxide-sGC-cyclic guanosine monophosphate (cGMP) pathway, thereby restoring endothelial and myocardial signaling beyond neurohormonal blockade [4].After the “The Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction” (VICTORIA) trial demonstrated a reduction in the composite of CV death or first HF hospitalization in patients with recently worsened HF and left ventricular ejection fraction (LVEF) ≤45 [5], vericiguat secured guideline endorsement as an adjunctive option for high-risk patients in HFrEF [1, 2]. Recently, the VICTOR (Vericiguat Global Study in Participants with Chronic Heart Failure) trial extended evaluation to stable ambulatory patients [6]. Yet both pivotal studies were dominated by Western cohorts, in fact, just under 20% of the subjects were of Asian origin [7] and excluded many individuals with low blood pressure. In this context, Zhou et al. [8] provide a distinctive contribution with their study “Vericiguat in Chinese patients with heart failure and reduced ejection fraction: a real-world prospective study” (Cardiology, 2025).The authors conducted a single-center prospective study enrolling 207 Chinese adults with chronic HF and a LVEF ≤45% on background guideline-directed medical therapy and followed them for a median of 11.25 months. After 1:1 propensity-score matching (PSM), 75 patients treated with vericiguat were compared with 75 matched controls. The investigators observed at the univariable Cox regression analysis a 73% relative reduction in CV mortality after PSM (HR 0.27 [95% CI: 0.09–0.81]; p = 0.019) and a trend toward fewer HF hospitalizations (HR 0.59 [95% CI: 0.35–0.99]; p = 0.045 before PSM, but nonsignificant after matching), without any reported deterioration in blood pressure or renal function.This design marks the first prospective, practice-based, Chinese cohort evaluating vericiguat outside the rigid structure of a randomized clinical trial (RCT). The enrolled population closely mirrors daily cardiology practice: mean systolic blood pressure ≈ 119 mm Hg and mean LVEF ≈ 31%; both these data are in line with RCTs conducted previously with vericiguat [5, 6]. ARNIs use was 59%, in accord with the most recent data in the literature [9]; while that of sodium-glucose cotransporter-2 inhibitor (44%) was not optimal, although higher than that which emerged from the data of the combined analysis of the VICTOR and VICTORIA [7].In such fragile patients – often excluded from large trials – the drug proved to be feasible to use and well tolerated. By prospectively monitoring outcomes in a real-life setting, the investigators fill a major evidence gap for Asian populations, specifically Chinese, and for clinicians dealing with hypotension-limited therapeutic optimization.Beyond confirming feasibility of vericiguat use, Zhou et al. [8] provide original physiological and clinical insights. The mortality benefit persisted after propensity matching and remained consistent in sensitivity analyses, suggesting that the signal is not an artefact of baseline imbalance. In exploratory subgroup analyses, a trend toward greater benefit was observed in patients with lower LVEF (