Evidence map›Paper›PMID 40977249›Full record

Trial reportESC heart failure2025

Geographic region variation in patient characteristics, clinical outcomes and treatment of HFrEF in the VICTORIA trial.

Cynthia M Westerhout, Wendimagegn Alemayehu, Alain Cohen-Solal, Carolyn S P Lam, Justin A Ezekowitz, Stefano Corda, Ciaran J McMullan, Christopher M O'Connor, Paul W Armstrong, VICTORIA Study Group

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in ESC heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Cynthia M WesterhoutCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.ORCID https://orcid.org/0000-0003-1082-5981
Wendimagegn AlemayehuCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.ORCID https://orcid.org/0000-0002-8549-7962
Alain Cohen-SolalUniversité Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France.
Carolyn S P LamNational Heart Centre Singapore and Duke-National University of Singapore, Singapore.
Justin A EzekowitzCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
Stefano CordaBayer AG, Basel, Switzerland.
Ciaran J McMullanMerck & Co., Inc., Rahway, New Jersey, USA.
Christopher M O'ConnorInova Schar Heart and Vascular, Falls Church, Virginia, USA.
Paul W ArmstrongCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.ORCID https://orcid.org/0000-0002-0460-3445
VICTORIA Study Group

Funding

Bayer AGMerck Sharp & Dohme LLC
6 · The paper itself

Abstract

aimsHeterogeneity in demographics, aetiology, healthcare access and guideline-directed medical therapy (GDMT), and survival bias of patients with heart failure with reduced ejection fraction (HFrEF) is evident from international trials and registries. The current study examines conventional geographic variation in participants' phenotypes, standard of care, clinical outcomes and treatment effects of vericiguat versus placebo within the VICTORIA trial. We then evaluate an alternative approach to assessing the relationship between geographic variation in the efficacy of new therapeutics. METHODS AND

resultsCharacteristics, standard of care and outcomes (time to first HF hospitalization (HFH) or cardiovascular death (CVD), time to first HFH and to CVD) of the 5050 participants from 42 countries and the effect of vericiguat versus placebo were analysed according to five prespecified geographic regions. Further examination of the study treatment effect according to country-level human development index (HDI) was undertaken to evaluate intra-regional variation. Notable inter-region differences existed in participant characteristics, standard of care at randomization and clinical outcomes. There was no modification of vericiguat's treatment benefit across geographic regions for the primary composite endpoint or its components. When examined by HDI, vericiguat's benefit on HFH and the primary composite was retained overall but attenuated as HDI rose (P

conclusionsGeographic variation in the phenotype of patients with HFrEF, standard of care, and clinical outcomes was observed, while there was no intra-regional heterogeneity in vericiguat's treatment effect. However, when considering contextual/systemic measures via country-level HDI, further insights into treatment effect were revealed. Country-level measures may be helpful in the planning of future trials and in the translation of evidence into practice.

Indexed as

BenzaldehydesHeart FailureHeterocyclic Compounds, 2-RingStroke VolumeAgedFemaleFollow-Up StudiesHospitalizationHumansMaleMiddle AgedPyrimidinesTreatment OutcomeVictoriaBenzaldehydesHeterocyclic Compounds, 2-RingPyrimidinesvericiguatCongestive heart failureGeographic regionsHeterogeneityVericiguat

Identifiers

PMID40977249
PMCPMC12719836

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.