A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction (HFrEF) (MK-1242-001)

This is a randomized, placebo-controlled, parallel-group, multi-center, double-blind, event driven study of vericiguat (MK-1242) in participants with heart failure with reduced ejection fraction (HFrEF). The primary hypothesis is vericiguat (MK-1242) is superior to placebo in increasing the time to first occurrence of the composite of cardiovascular (CV) death or heart failure (HF) hospitalization in participants with HFrEF.


Eligibility Criteria:
Inclusion Criteria:

* History of chronic HF (New York Heart Association \[NYHA\] Class II-IV) on standard therapy before qualifying HF decompensation
* Previous HF hospitalization within 6 months prior to randomization or intravenous (IV) diuretic treatment for HF (without hospitalization) within 3 months.
* Brain natriuretic peptide (BNP) levels: sinus rhythm-≥ 300 pg/mL; atrial fibrillation-≥ 500 pg/mL and N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) levels: sinus rhythm- ≥ 1000 pg/mL; atrial fibrillation - ≥ 1600 pg/mL within 30 days prior to randomization
* Left ventricular ejection fraction (LVEF) of \<45% assessed within 12 months prior to randomization by any method
* If female, is not of reproductive potential or agrees to avoid becoming pregnant while receiving study drug and for 14 days after the last dose of study drug by complying with one of the following: practice abstinence from heterosexual activity or use (or have her partner use) acceptable contraception during heterosexual activity.

Exclusion Criteria:

* Clinically unstable at the time of randomization as defined by either the administration of any IV treatment within 24 hours prior to randomization, and/or systolic blood pressure (SBP) \<100 mmHg or symptomatic hypotension
* Current or anticipated use of long-acting nitrates or nitric oxide (NO) donors including isosorbide dinitrate, isosorbide 5-mononitrate, pentaerythritol tetranitrate, nicorandil or transdermal nitroglycerin (NTG) patch, and molsidomine
* Current or anticipated use of phosphodiesterase type 5 (PDE5) inhibitors such as vardenafil, tadalafil, and sildenafil
* Current use or anticipated use of a soluble guanylate cyclase (sGC) stimulator such as riociguat
* Known allergy or sensitivity to any sGC stimulator
* Awaiting heart transplantation (United Network for Organ Sharing Class 1A / 1B or equivalent), receiving continuous IV infusion of an inotrope, or has/anticipates receiving an implanted ventricular assist device
* Primary valvular heart disease requiring surgery or intervention, or is within 3 months after valvular surgery or intervention
* Hypertrophic obstructive cardiomyopathy
* Acute myocarditis, amyloidosis, sarcoidosis, Takotsubo cardiomyopathy
* Post-heart transplant cardiomyopathy
* Tachycardia-induced cardiomyopathy and/or uncontrolled tachyarrhythmia
* Acute coronary syndrome (unstable angina, non-ST elevation myocardial infarction \[NSTEMI\], or ST elevation myocardial infarction \[(STEMI\]) or coronary revascularization (coronary artery bypass grafting \[CABG\] or percutaneous coronary intervention \[PCI\]) within 60 days, or indication for coronary revascularization at time of randomization
* Symptomatic carotid stenosis, transient ischemic attack (TIA) or stroke within 60 days
* Complex congenital heart disease
* Active endocarditis or constrictive pericarditis
* Estimated glomerular filtration rate (eGFR) \<15 mL/min/1.73 m2 or chronic dialysis
* Severe hepatic insufficiency such as with hepatic encephalopathy
* Malignancy or other non-cardiac condition limiting life expectancy to \<3 years
* Require continuous home oxygen for severe pulmonary disease
* Current alcohol and/or drug abuse
* Participated in another interventional clinical study and treatment with another investigational product ≤30 days prior to randomization or plans to participate in any other trial/investigation during the duration of this study
* Mental or legal incapacitation and is unable to provide informed consent
* Immediate family member (e.g., spouse, parent/legal guardian, sibling or child) who is involved with this study
* Interstitial Lung Disease
* Is pregnant or breastfeeding or plans to become pregnant or to breastfeed during the course of the study