VERISEC: vericiguat in de praktijk halveert hartfalen-decompensaties bij HFrEF — Spaanse 1-jaars registry van 835 patiënten

Aims: To evaluate the effectiveness and safety of vericiguat in patients with heart failure and reduced ejection fraction (HFrEF) following recent decompensation in routine clinical practice in Spain. Methods: VERISEC is a prospective, multicenter registry of 835 consecutive patients initiating vericiguat at 41 centers in Spain. Functional class, biochemical markers, ventricular function, and clinical events were analyzed during 1-year follow-up. Results: Patients (age 71.3 years [SD 11.2], 78.9% male) received highly optimized baseline therapy: 91.5% SGLT2i, 90.7% beta-blockers, 85.4% RAASi, and 79.8% MRAs. Quadruple therapy remained stable (61.7% baseline to 63.0% at 12 months; p=0.526). At 1-year follow-up, significant improvements were observed: NT-proBNP decreased from 3,532 to 2,292 pg/mL (p<0.001) and LVEF increased from 30.3% to 35.4% (p<0.001). NYHA class improved, with class II patients increasing from 55.6% to 62.2% (p<0.001). Mean HF decompensations requiring intravenous diuretics decreased from 1.34/year pre-treatment to 0.65/year during follow-up (≈51% reduction). Non-HF cardiovascular hospitalizations decreased from 0.98 to 0.39 per year. Vericiguat was discontinued in 13.4% of patients, primarily due to symptomatic hypotension (49.4% of discontinuations). Higher baseline NT-proBNP independently predicted discontinuation (OR 1.06 per 1,000-pg/mL increase; 95% CI 1.03–1.08; p<0.001). Conclusions: In a large real-world Spanish cohort initiating vericiguat after HF decompensation, treatment was associated with improved biomarkers, LV function and functional class, and a halving of HF decompensations — confirming and extending the VICTORIA trial in routine practice.