Quality evaluation of the guidelines for vericiguat treatment of heart failure with reduced ejection fraction

Heart failure (HF) bears a heavy disease burden, and vericiguat is the only guanylate cyclase stimulator proved to improve its prognosis. However, its clinical use needs a further improvement.

To evaluate the quality of the guidelines for vericiguat treatment of heart failure with reduced ejection fraction (HFrEF) using the Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) instrument, thus providing references for clinical decision-making.

Clinical guidelines for vericiguat treatment of HFrEF published before 31st March, 2024 were systematically searched in online databases, including the CNKI, Wanfang, VIP, SinoMed, Cochrane Library, Pubmed, and Embase. Eligible articles were screened out by two investigators independently. Quality of the guidelines for vericiguat treatment of HFrEF was evaluated by four investigators from different professional groups using the AGREE Ⅱ instrument.

A total of seven guidelines for vericiguat treatment of HFrEF were enrolled for quality evaluation. Among them, the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure graded the highest score, followed by the 2021 CCS/CHFS Heart Failure Guidelines Update, and the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. The Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2023 graded in a moderate level. Significant differences were observed in scores of the stakeholder involvement, rigor of development, and editorial independence. Generally, guidelines for vericiguat treatment of HFrEF shared similar contents, with a moderate quality of evidence. Except for the Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2023, and the Korean Society of Heart Failure Guidelines for the Management of Heart Failure 2023 evaluated with a stronger recommendation, the remaining guidelines for vericiguat treatment of HFrEF were equipped with a weaker recommendation.

Referring to guidelines with higher quality, vericiguat is an option for HFrEF patients with a short-term aggravation. Existing recommodations for vericiguat treatment of HFrEF are formulated highly dependent on the findings from the VICTORIA trial, leading to potential biases. More clinical trials are needed for validating the efficacy and safety of vericiguat in treating HFrEF.