The Role of Vericiguat in Heart Failure Therapy: From Clinical Trials to Clinical Practice

Heart failure with reduced ejection fraction (HFrEF) is a progressive condition that is associated with high rates of morbidity, frequent hospitalizations, and significant mortality. Despite advancements in guideline-directed medical therapy (GDMT), many patients continue to be at risk for worsening heart failure (WHF). Vericiguat is a novel soluble guanylate cyclase (sGC) stimulator that targets the impaired nitric oxide (NO)–sGC–cyclic guanosine monophosphate (cGMP) pathway. Thus, by improving vascular and myocardial function, vericiguat offers a promising therapeutic option for patients with HFrEF who remain symptomatic despite receiving optimal medical treatment. This review explores the pathophysiological rationale, mechanism of action, and clinical evidence supporting the use of vericiguat. We analyze data from key randomized controlled trials (RCTs), such as SOCRATES-REDUCED and VICTORIA, as well as meta-analyses, to assess the efficacy and safety of using vericiguat in HFrEF. Additionally, we review real-world studies to evaluate the applicability of vericiguat in clinical practice.