Refractory HFrEF — RACP Adult Medicine MCQ

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HardCardiologyRefractory HFrEFRACP Adult Medicine

A 55-year-old man with known dilated cardiomyopathy (LVEF 20%) on optimal quadruple therapy (sacubitril/valsartan, bisoprolol, spironolactone, dapagliflozin) remains NYHA class III. His ferritin is 180 µg/L and TSAT is 22%. NT-proBNP is 3500 pg/mL. Which additional agent may reduce hospitalisation?

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Correct answer: A — Vericiguat

Vericiguat (a soluble guanylate cyclase stimulator) was shown in the VICTORIA trial to reduce the composite of cardiovascular death or heart failure hospitalisation in patients with recent worsening HFrEF despite optimised GDMT. It enhances the NO-sGC-cGMP pathway. The Australian heart failure consensus statement includes vericiguat as an option for persistent HFrEF. It is used when patients remain symptomatic despite maximised foundational four-pillar therapy.

Reference: NHF/CSANZ – 2022 – Heart Failure Consensus Statement; eTG – 2025 – Cardiovascular