Despite advances in guideline-directed medical therapy, patients with heart failure with reduced ejection fraction remain at high risk of morbidity and mortality. Data from the European Society of Cardiology Congress 2025 compared baseline therapy use among 1,438 real-world vericiguat initiators with participants in the VICTOR and VICTORIA trials.

Analysis revealed that real-world patients had lower use of beta-adrenergic blockers (77.3 percent versus 93.1 percent), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (23.2 percent versus 73.5 percent), and mineralocorticoid receptor antagonists (43.3 percent versus 70.4 percent) compared with VICTORIA trial participants. 

Conversely, the use of angiotensin receptor-neprilysin inhibitors (58.8 percent versus 14.5 percent) and sodium-glucose cotransporter-2 inhibitors (44.6 percent versus 3.1 percent) was higher, aligning more closely with VICTOR trial patterns. The cohort also included a higher proportion of Black patients, reflecting the United States heart failure population.

These findings underscore a persistent gap between clinical trial protocols and real-world practice. Optimizing background therapy in patients receiving vericiguat could improve outcomes, highlighting the need for targeted strategies to align treatment with guideline-directed standards.