Using biomarkers to "guide" heart failure management: current perspectives and future directions

Over the last several years, cardiac biomarkers have proven to be increasingly useful for disease screening, diagnosis, and prognostication. The most widely used biomarkers in heart failure (HF) are natriuretic peptides (NPs), which can aid in diagnosing HF, while also identifying those who are at higher risk of adverse outcomes. Multiple clinical trials have investigated the role of NPs as therapeutic targets for HF management, but results have been conflicting. Collectively, however, the data suggest that NP levels may be useful in guiding HF management and improving HF-related morbidity and mortality. In this review, we summarize existing data investigating the use of NPs as targets for outpatient HF therapy, focusing on differences in study designs and lessons learned from the results. Although the results for this approach are promising overall, we propose that additional well-designed prospective randomized controlled trials-specifically incorporating the relevant lessons learned from previous studies-are necessary to pivotally establish the role of NP-guided outpatient HF management.