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Real-world eligibility for vericiguat in decompensated heart failure with reduced ejection fraction

 Jaewon Oh  ;  Chan Joo Lee  ;  Jin Joo Park  ;  Sang Eun Lee  ;  Min-Seok Kim  ;  Hyun-Jai Cho  ;  Jin-Oh Choi  ;  Hae-Young Lee  ;  Kyung-Kuk Hwang  ;  Kye Hun Kim  ;  Byung-Su Yoo  ;  Dong-Ju Choi  ;  Sang Hong Baek  ;  Eun-Seok Jeon  ;  Jae-Joong Kim  ;  Myeong-Chan Cho  ;  Shung Chull Chae  ;  Byung-Hee Oh  ;  Seok-Min Kang 
 ESC HEART FAILURE, Vol.9(2) : 1492-1495, 2022-04 
Journal Title
Issue Date
Heart Failure* ; Heterocyclic Compounds, 2-Ring ; Hospital Mortality ; Humans ; Prospective Studies ; Pyrimidines ; Stroke Volume / physiology ; Ventricular Function, Left
Clinical pharmacology ; Eligibility ; Heart failure ; Registries ; Vericiguat
Aims In 2021, vericiguat was approved by the US Food and Drug Administration (FDA) and the European Commission (EC) for reducing cardiovascular mortality and heart failure (HF) hospitalizations in patients with HF with reduced ejection fraction (HFrEF) based on the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial. However, there has been no report for characterizing the generalizability of vericiguat to real-world clinical practice. Methods and results The Korean Acute Heart Failure (KorAHF) registry is a multicentre prospective cohort study. A total of 5625 patients who were admitted for HF decompensation were consecutively enrolled. We excluded the patients without left ventricular ejection fraction (LVEF) quantification, patients with LVEF > 45%, patients with in-hospital death or urgent heart transplantation, and patients without natriuretic peptide measurement. Among a total of 3014 enrolled patients, there were 21.9% patients with lower systolic blood pressure (SBP) (<100 mmHg) and 20.1% patients without elevated natriuretic peptide. Regarding chronic kidney disease (CKD) status, 5.1% patients had CKD Stage V [estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 ] and 11.8% patients had CKD Stage IV (15 ≤ eGFR < 30 mL/min/1.73 m2 ). When we analysed these criteria sequentially, 21.9% were excluded from lower SBP, 15.9% were excluded from elevated natriuretic peptide, and 4.2% were excluded from advanced CKD Stage V (9.6% for CKD Stages IV and V). Among the KorAHF registry patients, we found two main reasons for not meeting the inclusion criteria of the VICTORIA trial such as low SBP and non-elevated natriuretic peptide. Conclusions Among the Korean hospitalized HFrEF patients, 94.9% met the FDA/EC label criteria, while 58% met the inclusion criteria of the VICTORIA trial. Our findings suggest the need for better strategies to integrate up-to-date HF treatment in a real-world HF population, especially decompensated HF patients with low SBP and non-elevated natriuretic peptide.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
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