{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:04:48Z","timestamp":1785323088718,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Elderly patients with heart failure (HF) represent a rapidly growing and highly heterogeneous population marked by multimorbidity, frailty, and polypharmacy. These age-related features profoundly influence the course of HF and modify therapeutic response. Vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, targets the impaired nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) pathway, a central mechanism in vascular dysfunction and maladaptive remodelling. Clinical evidence, primarily from the VICTORIA trial and subsequent studies, supports vericiguat in selected patients with heart failure with reduced ejection fraction (HFrEF), particularly following recent worsening HF despite guideline-directed medical therapy (GDMT). Most of the available evidence derives from HFrEF populations, whereas studies in heart failure with preserved ejection fraction (HFpEF) have not demonstrated significant clinical benefit. In addition, dedicated evidence in frail older adults and in patients with geriatric syndromes remains limited. This review summarises current knowledge on the pharmacological rationale, pharmacokinetics, and pivotal clinical studies of vericiguat, highlighting quantitative results and their implications for clinical implementation in elderly patients with HFrEF and complex clinical profiles.<\/jats:p>","DOI":"10.3390\/jcm15155918","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:13:47Z","timestamp":1785320027000},"page":"5918","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vericiguat in Elderly Patients with Heart Failure and Reduced Ejection Fraction: Clinical Perspectives from Pathophysiology to Implementation"],"prefix":"10.3390","volume":"15","author":[{"given":"Carmelo Massimiliano","family":"Rao","sequence":"first","affiliation":[{"name":"Cardiology Unit, Santa Maria Degli Ungheresi Hospital, Polistena, 89024 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5369-5382","authenticated-orcid":false,"given":"Fabiana","family":"Luc\u00e0","sequence":"additional","affiliation":[{"name":"Cardiology Department, Grande Ospedale Metropolitano of Reggio Calabria, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Ceravolo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Massimo","family":"Gulizia","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7746-989X","authenticated-orcid":false,"given":"Sandro","family":"Gelsomino","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Maastricht University Hospital, 6229 Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Ingianni","sequence":"additional","affiliation":[{"name":"Cardiologic District, Azienda Sanitaria Provinciale Trapani, 91016 Trapani, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1469-1714","authenticated-orcid":false,"given":"Marco","family":"Vatrano","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cPugliese\u201d Hospital, \u201cRenato Dulbecco\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Chiappetta","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cSantissima Annunziata\u201d Hospital, 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Scarpino","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cPugliese\u201d Hospital, \u201cRenato Dulbecco\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0092-8717","authenticated-orcid":false,"given":"Giovanna","family":"Geraci","sequence":"additional","affiliation":[{"name":"Cardiology Department, Sant\u2019Antonio Abate Hospital, Erice, 91016 Trapani, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9459-2488","authenticated-orcid":false,"given":"Fabrizio","family":"Oliva","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7743-2587","authenticated-orcid":false,"given":"Federico","family":"Nardi","sequence":"additional","affiliation":[{"name":"Cardiology Department, Santo Spirito Hospital, Casale Monferrato, 15033 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9347-8884","authenticated-orcid":false,"given":"Massimo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Cardiology Department, General Regional Hospital \u201cF. 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