Vericiguat in Decompensated Cardiac Failure: Clinical Insights on Addition to Guidelines-Derived Medical Therapy

Objective: To assess the efficacy of vericiguat compared to placebo in patients with decompensated heart failure, focusing on key outcomes such as hospitalisation rates, cardiovascular death, and side effects like gastrointestinal disturbances and hypotension. Methodology: A total of 130 patients were enrolled in a randomised controlled trial conducted at the Armed Forces Institute of Cardiology, Rawalpindi, from January 2026 to April 2026. Participants were randomly assigned to receive either vericiguat (n = 64) or placebo (n = 66). The primary outcomes were hospitalisation, cardiovascular death, and side effects, which were assessed through chi-square tests, t-tests, and descriptive statistics. Results: The study found no statistically significant differences between the vericiguat and placebo groups. Hospitalisation rates were 60.94% (n = 39) for vericiguat and 45.45% (n = 30) for placebo (p = 0.111). Cardiovascular death occurred in 46.88% (n = 30) of the vericiguat group and 59.09% (n = 39) of the placebo group (p = 0.223). Gastrointestinal disturbances were reported by 59.38% (n = 38) of Vericiguat patients and 56.06% (n = 37) of Placebo patients (p = 0.838). Hypotension occurred in 51.56% (n = 33) of vericiguat patients and 56.06% (n = 37) of placebo patients (p = 0.735). Conclusion: This study found no significant benefit of Vericiguat over Placebo in reducing hospitalisation, cardiovascular death, or side effects in patients with decompensated heart failure. Larger multicentre studies are recommended to confirm these findings and explore potential treatment strategies in diverse populations. Keywords: Cardiovascular Death, Heart Failure, Hospitalisation, Side Effects, Vericiguat