While neurohormonal antagonists and SGLT2 inhibitors improve heart failure with reduced ejection fraction (HFrEF), residual mortality remains high, prompting investigation of cyclic GMP pathway enhancement . The double-blind, randomized, event-driven VICTOR trial enrolled 6,105 ambulatory patients with stable chronic HFrEF (ejection fraction ≤40%) and randomized them 1:1 to oral vericiguat (titrated to 10 mg daily) or placebo on top of guideline-directed medical therapy. Vericiguat significantly reduced cardiovascular mortality by 17% (relative risk reduction, P < .050) and all-cause mortality by 16% (P < .050).

Significant relative risk reductions were also documented for sudden cardiac death (25%) and heart failure-related death (29%). These findings establish that vericiguat provides distinct survival benefits in stable ambulatory HFrEF beyond immediate post-worsening scenarios.…