Work

Initiation, titration, and safety of vericiguat for treatment of heart failure in United States clinical practice

Year: 2026

Type: article

Abstract: Study objective To evaluate the following among new users of vericiguat: up-titration patterns, factors associated with up-titration, occurrence of hypotension/syncope, predictors of hypotension/syncope. Design Retrospective cohort study (linked claims and electronic health record data). Setting US clinical practice. Participants 1361 new users of vericiguat. Interventions N/A. Main outcome measures Vericiguat starting dose, up-titration patterns and predictors, hypotension/syncope occurrence and predictors, over a 3-month follow-up period. Results Starting dose was: 2.5 mg/day: 57%, 5 mg/day: 24%, 10 mg/day: 19%. The 10 mg target dose was reached by 349 patients (26%). Among these, the median time to reach the 10 mg dose was 60 days (2.5 mg/day starters) and 41 days (5 mg/day starters). Among the 2.5 mg starters, 68% had no up-titration. Among the 2.5 mg/5 mg starters, a starting dose of 5 mg (vs. 2.5 mg) was the only significant predictor for reaching the 10 mg dose; adjusted hazard ratio 2.89 (95% CI: 1.86, 4.49, p < 0.0001). Overall, 130 patients (9.6%) had a hypotension event and 67 patients (4.9%) had a syncope event. History of hypotension was the strongest independent predictor of hypotension/syncope events (adj. HR 2.85, 95% CI: 1.96, 4.13, p < 0.0001). A > 2.5 mg/day vericiguat starting dose was not associated with the occurrence of hypotension/syncope (vs. 2.5 mg/day); adj. HR 0.82, 95% C.I. (0.58, 1.16). Conclusion Vericiguat users started on 5 mg/day were considerably more likely (HR 2.89) to reach the target dose of 10 mg/day vs. those started on the recommended 2.5 mg/day, without excess risk of hypotension or syncope.

Source: American Heart Journal Plus Cardiology Research and Practice

DOI: 10.1016/j.ahjo.2026.100721

Authors: Stephen J. Greene, Alexander Michel, Coralie Lecomte, Paolo Manca, Katsiaryna Holl, Michele Senni