Clinical adoption of prognostic biomarkers: the case for heart failure

Abstract

The recent explosion of scientific knowledge and technological progress has led to the discovery of a large array of circulating molecules commonly referred to as biomarkers. Biomarkers in heart failure (HF) research have been used to provide pathophysiologic insights, aid in establishing the diagnosis, refine prognosis, guide management, and target treatment. However, beyond diagnostic applications of natriuretic peptides, there are currently few widely recognized applications for biomarkers in HF. This represents a remarkable discordance considering the number of molecules that have been shown to correlate with outcomes, refine risk prediction, or track disease severity in HF in the past decade. In this article, we use a broad framework proposed for cardiovascular risk markers to summarize the current state of biomarker development for patients with HF. We use this framework to identify the challenges of biomarker adoption for risk prediction, disease management, and treatment selection for HF and suggest considerations for future research.

Figure 1

Number of articles including the terms “biomarker*” and “heart failure” 2001–2011. Source: Web of Science SM. Accessed March 31, 2012.

Figure 2

Framework and areas of uncertainty in the development of biomarkers in heart failure. Stages adapted from Hlatky MA et al, Circulation 2009;119:2408-2416.