Inpatient Insights
APhA Staff
Vericiguat may reduce hospitalizations for patients with HFrEF
Following completion of the VICTORIA trial, vericiguat was approved for the treatment of worsening heart failure with HFrEF. The subsequent VICTOR trial evaluated the use of vericiguat in patients with HFrEF and no recent worsening. A global group of researchers investigated the effect of vericiguat on clinical endpoints through pooled analyses of patient level data from the VICTORIA and VICTOR trials. The study was published in the September 27, 2025, issue of The Lancet.
The VICTORIA trial was active from November 2, 2021, to February 5, 2025, in 36 countries and enrolled adult participants with HFrEF with recent worsening (defined as either hospitalization for heart failure within the previous 6 months or outpatient use of I.V. diuretics within the previous 3 months) and increased NT-proBNP concentrations. The VICTOR trial had similar eligibility criteria, but participants had no recent worsening of heart failure. Patients in both trials were randomized 1:1 to receive oral vericiguat, titrated from a starting dose of 2.5 mg to a 10 mg target daily dose or matching placebo. The primary endpoint was a composite endpoint of cardiovascular death or hospitalization for heart failure (also assessed individually).
The analysis involved more than 11,000 patients (5,050 in the VICTORIA trial and 6,105 in the VICTOR trial). Cardiovascular death or hospitalization for heart failure occurred in 25.9% of patients in the vericiguat group and 27.9% of patients in the placebo group with similar reductions in its individual components of cardiovascular death and hospitalization for heart failure as first events. The authors concluded that vericiguat may be suitable as an additional treatment option for select patients with HFrEF. ■
Risperidone may increase risk of stroke in patients with dementia
Up to half of patients with dementia experience agitation and aggression over the course of the disease. Nonpharmacological interventions are used as first-line treatment strategies, but antipsychotics are prescribed when these nonpharmacological interventions are ineffective. However, treatment with antipsychotics in patients with dementia can increase the incidence of stroke. In a study published online on October 9, 2025, in The British Journal of Psychiatry, a group of researchers from the U.K. evaluated the risk of stroke associated with risperidone across different patient subgroups defined by stroke and CVD history.
Anonymized primary care data from the U.K.-based Clinical Practice Research Datalink were used to identify individuals diagnosed with dementia after the age of 65 years between 2004 and 2023. The researchers compared the risk of stroke over 1 year between individuals initiating risperidone (28,403 patients) and propensity score–matched controls (136,324 patients) across subgroups with and without history of stroke and any CVD. Overall, risperidone treatment was associated with increased risk of stroke, particularly in those with a prior history of stroke and CVD, compared with the overall cohort.
The authors concluded that use of risperidone exacerbates the risk of stroke in patients with dementia regardless of whether the patient has a prior history of CVD. They suggest that these results may help with communication of risk and aid more judicious prescribing. ■
Medication provision for OUD is low in EDs
Drug overdose deaths in the United States have decreased substantially in recent years, at least partially due to increased efforts to improve treatment of nonfatal overdose events responded to by emergency medical services and in hospital emergency departments (EDs). Researchers from Johns Hopkins University and Brown University assessed practices surrounding provision of naloxone and other medication for OUD in a large sample of EDs participating in a quality improvement initiative. The study was published online on October 9, 2025, in Annals of Emergency Medicine.
Data were obtained from EDs participating in the American College of Emergency Physicians’ Emergency Quality Network SUD program, a national practice-based quality improvement initiative. Each site abstracted data elements from a random sample of discharge visits with diagnosis codes for opioid overdose or OUD and determined the percentages of visits for which naloxone was prescribed or dispensed and medication for OUD was administered or prescribed. Data were reported from 300 unique EDs.
Of the almost 6,800 visits for overdose or OUD reported, naloxone was either dispensed or prescribed in 27.8% of visits. It was reported that the patient was already taking medication for OUD in 11.1% of visits, and excluding those visits, medication for OUD was either administered in the ED or prescribed at discharge in 7.3% of potentially eligible visits. The authors suggested that their findings indicate opportunity for improvement of OUD care in the ED. ■
Is non–β-lactam surgical antimicrobial prophylaxis associated with increased SSIs?
Surgical site infections (SSIs) are one of the most frequent complications following surgical procedures, and to mitigate SSI risk, preoperative surgical antimicrobial prophylaxis has become standard practice. β-lactam–based antimicrobial prophylaxis is the standard for most surgical procedures, though non–β-lactam prophylaxis is sometimes used, primarily due to allergies. Researchers from five university hospitals in Switzerland investigated the association between the use of non–β-lactam surgical antimicrobial prophylaxis and an increased risk of SSIs. The cohort study was based on the Swissnoso SSI surveillance system of 175 hospitals, including adult patients who underwent a major surgical procedure with prophylaxis administration within 120 minutes prior to incision.
The main outcome of the study, published online in JAMA Network Open on October 31, 2025, was the occurrence of an SSI, according to CDC definitions. Of the almost 540,000 patients studied, a b-lactam antibiotic was administered to 98.3% of patients while a non–β-lactam antibiotic was administered to 1.7% of patients. An SSI was diagnosed in 2.8% of the patients who received β-lactam prophylaxis compared with 6.1% of patients who received non–β-lactam prophylaxis. A higher SSI rate for non–β-lactam prophylaxis was found across all procedure types. Secondary analyses found a higher risk of SSI for ciprofloxacin, vancomycin, and clindamycin compared with β-lactam surgical antimicrobial prophylaxis.
The researchers concluded that their findings suggest that non–β-lactam prophylaxis should be avoided whenever possible and that a careful evaluation of patients with reported β-lactam allergy should be performed before administering a second-choice antibiotic. ■