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Published on: June 10, 2025
Biomarkers of risk stratification in congestive heart failure: North American view
1Section of Heart Failure & Cardiac Transplantation Medicine, Department of Cardiovascular Medicine, Heart & Vascular Institute, The Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA. tangw@ccf.org
Insights
Cardiac and noncardiac biomarkers aid heart failure diagnosis and management in North America. While useful for risk stratification, translating research into practice and demonstrating cost-effectiveness remain key challenges for these diagnostic tools.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Biomarker Research
Background:
- Biomarkers are widely used in North American clinical practice for diagnosing and managing heart failure.
- Key objectives for biomarker testing include diagnosis, understanding pathophysiology, assessing severity, predicting adverse events, and monitoring treatment response.
Purpose of the Study:
- To review the current clinical utility and challenges of cardiac and noncardiac biomarkers in heart failure management.
- To highlight the need for improved translation of research evidence into clinical practice and cost-effective application of biomarkers.
Main Methods:
- Review of current clinical practices and literature regarding biomarker use in heart failure.
- Analysis of the objectives and limitations of biomarker testing in clinical settings.
Main Results:
- Cardiac-specific biomarkers like natriuretic peptides and troponin aid in identifying patients at risk.
- Challenges persist in translating research findings into clinical practice and demonstrating clear benefits of current therapeutic options based on biomarker data.
- Prognostic information from commonly ordered tests may be overlooked, and their impact on prognosis requires further clarification.
Conclusions:
- Biomarker testing serves multiple objectives in heart failure care, with growing experience in cardiac biomarkers improving risk identification.
- Further research is needed to bridge the gap between evidence and practice, optimize the use of existing biomarkers, and ensure their clinical utility demonstrates safety and incremental benefits amidst rising healthcare costs.
Abstract:
There is broad adoption of various cardiac and noncardiac biomarkers in clinical practices across North America for the diagnosis and management of heart failure. Like any clinical condition, there are several overall objectives in biomarker testing: to establish or refute a diagnosis of heart failure and/or cardiac dysfunction; to understand the underlying pathophysiologic processes that may warrant specific interventions; to determine the level of disease severity in a manner to triage medical decisions; to detect and potentially avoid adverse consequences as a result of therapeutic interventions; and to monitor responses to treatment. While at present no single biomarker can serve all of these objectives, the growing experience with cardiac-specific biomarkers, such as natriuretic peptide and cardiac troponin testing, has allowed clinicians to better identify those at heightened short- or long-term risk. It is clear that difficulty remains in translating research evidence into clinical practice. While studies demonstrate statistical differences in short- and long-term outcomes, there is still limited information on how such improvements can be achieved solely based on current therapeutic options. Meanwhile, many commonly ordered tests have important prognostic information that can be overlooked, yet their changes may or may not affect prognosis. With healthcare cost on the rise in North America, clinical utility of biomarkers must demonstrate relative safety and potential incremental benefits to standard approaches.
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