Vericiguat, approved to reduce cardiovascular death and hospitalization in adults with symptomatic heart failure with reduced ejection fraction, demonstrates substantial benefit when titrated to the 10 mg target dose. The 2025 European Society of Cardiology (ESC) Heart Failure Guidelines emphasize achieving target doses of guideline-directed therapies, including vericiguat, to optimize outcomes.

A real-world analysis using the Komodo Research Database evaluated 1,438 patients initiating vericiguat between January 2021 and October 2023. Only 470 (32.7%) achieved 10 mg within three months. Among 527 patients with a worsening heart failure event in the preceding six months, 179 (34%) reached the target dose. Baseline characteristics and medication patterns were comparable between those achieving lower and target doses.

Adjusted analyses showed that patients on 10 mg had a 34% lower risk of heart failure–related hospitalization (HR 0.66; 95% CI, 0.51–0.84; p = 0.001), similar risk reduction for worsening heart failure events (HR 0.66; p < 0.001), and lower composite risk of hospitalization or death (HR 0.64; p < 0.001) versus those on 2.5 or 5 mg. These findings reinforce the clinical and healthcare resource benefits of achieving full-dose vericiguat and highlight the importance of proactive uptitration in eligible patients.