Even with the widespread availability of vericiguat for heart failure with reduced ejection fraction, many patients in routine care remained undertreated with key heart failure drugs. The 2025 European Society of Cardiology (ESC) presentation emphasized this treatment gap by comparing real-world practice to major vericiguat trials.

Using the Komodo Research Database, investigators evaluated 1,438 adults with heart failure who initiated vericiguat between 2020 and 2023, including 527 with a recent worsening event. Baseline medication use was compared with that of participants from the pivotal VICTORIA and ongoing VICTOR trials.

Real-world patients showed lower rates of beta-blocker, renin-angiotensin system, and mineralocorticoid receptor antagonist use, though they had higher adoption of angiotensin receptor–neprilysin inhibitors and SGLT2 inhibitors. The real-world cohort more closely matched the VICTOR population than VICTORIA, but overall medication optimization remained suboptimal.

These findings underscored the need for improved implementation of guideline-directed therapy among vericiguat users in the community, ensuring patients receive comprehensive pharmacologic support alongside newer heart failure agents.