Study suggests dosing of heart failure medication can be safely simplified

An estimated 32 million people globally have heart failure with reduced ejection fraction, a condition where the lower left chamber of the heart does a poor job of pumping blood to the rest of the body.

While there are approved medications for the condition, not all providers escalate patient doses to target levels, increasing the risk of adverse events, hospitalizations and death.

In a study led by a Duke scientist—presented at a late-breaking research session on May 17 at the 2025 European Society of Cardiology Heart Failure conference and to be published May 20 in the European Journal of Heart Failure—researchers found patients could safely start vericiguat (a medication for heart failure with reduced ejection fraction) at a dose of 5 mg instead of the conventional 2.5 mg starting dose, streamlining the process to reach target dosing from three steps to two.

Stephen Greene, M.D., is the corresponding author of the study and associate professor in the Department of Medicine in the Duke University School of Medicine. He said reducing the steps to target dosing could help overcome clinical inertia.

“In real-world practice, most patients never achieve the target doses of recommended heart failure medications,” Greene said. “Despite clinic visit after clinic visit, medication changes are relatively rare. If titration of heart failure medications is rare in clinical practice, then it stands to reason that reducing the number of titration steps would give our patients a better chance to ultimately achieve target dosing.”

The study enrolled 106 patients across seven countries who started the 5 mg dose of vericiguat over the course of two weeks. The researchers compared safety and tolerability of the higher dose group with those of study participants receiving the current dosing standard. The study found safety measures for both groups to be comparable, with more than 9 out of 10 patients safely tolerating initiation of vericiguat at the higher 5 mg starting dose.

“I think simplicity is the key when we talk about implementation of heart failure medications in clinical practice,” Greene said. “Real-world settings come with logistical challenges, and oftentimes clinics are very busy with limited appointment availability and limited available time per patient. These factors unfortunately set a stage for clinical inertia and for patients to go without important medication changes. Simplifying the way that we initiate and titrate heart failure medications may help overcome this and improve the quality of care our patients receive.”