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Review
. 2023 Mar 24:17:839-849.
doi: 10.2147/PPA.S400403. eCollection 2023.

Optimization of Patient Pathway in Heart Failure with Reduced Ejection Fraction and Worsening Heart Failure. Role of Vericiguat

José Ramón González-Juanatey  1 , Josep Comín-Colet  2 , Domingo Pascual Figal  3 , Antoni Bayes-Genis  4 , Jose Maria Cepeda  5 , José M García-Pinilla  6   7 , Antonio García-Quintana  8 , Luis Manzano  9 , Jose Luis Zamorano  10
Affiliations
Review

Optimization of Patient Pathway in Heart Failure with Reduced Ejection Fraction and Worsening Heart Failure. Role of Vericiguat

José Ramón González-Juanatey et al. Patient Prefer Adherence. .

Abstract

Heart failure (HF) is a progressive condition with periods of apparent stability and repeated worsening HF events. Over time, unless optimization of HF treatment, worsening HF events become more frequent and patients enter into a cycle of recurrent events with high morbidity and mortality. In patients with HF there is an activation of deleterious neurohormonal pathways, such as the renin angiotensin aldosterone system and the sympathetic system, and an inhibition of protective pathways, including natriuretic peptides and guanylate cyclase. Therefore, HF burden can be reduced only through a holistic approach that targets all neurohormonal systems. In this context, vericiguat may play a key role, as it is the only HF drug that activates the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate system. On the other hand, it has been described relevant disparities in the management of HF population. Consequently, it is necessary to homogenize the management of these patients, through an integrated patient-care pathway that should be adapted at the local level. In this context, the development of new technologies (ie, video call, specific platforms, remote control devices, etc.) may be very helpful. In this manuscript, a multidisciplinary group of experts analyzed the current evidence and shared their own experience to provide some recommendations about the therapeutic optimization of patients with recent worsening HF, with a particular focus on vericiguat, and also about how the integrated patient-care pathway should be performed.

Keywords: heart failure; patient-care pathway; vericiguat; worsening heart failure.

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Conflict of interest statement

JRGJ reports fees for conferences and for participating in advisory boards for Bayer. JCC reports fees as a speaker from Bayer. DPF received personal fees, non-financial support and/or research grants from Bayer, Novartis, Astra Zeneca, Boehringer Ingelheim, Roche, Rovi, Vifor, Abbot, Pfizer, Servier and Medtronic. JMC reports fees for participating in advisory boards for Bayer. AGQ reports fees for lectures and conferences from Bayer, Daiichi-Sankyo, Pfizer, AstraZeneca, Boehringer Ingelheim, Novartis, and Rovi. LM reports fees for lectures and conferences from Novartis, Bayer, AstraZeneca and Pfizer. JLZ has reports fees for lectures from Bayer and Daiichi- Sankyo. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Components of the health care organization.
Figure 2
Figure 2
Health care pathway of a patient hospitalized with WHF.
Figure 3
Figure 3
Health care pathway of a patient with WHF firstly attended in the day hospital or the emergency department.
Figure 4
Figure 4
Baseline clinical characteristics and results of the primary outcome in the PARADIGM-HF, DAPA-HF, EMPEROR-Reduced and Victoria trials.
Figure 5
Figure 5
Therapeutic optimization of patients with recent WHF episode.
See this image and copyright information in PMC

References

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