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Opinion: Transitioning from Personalized to Precision Medicine for HF Patients

Key findings

  • The "one-fits-it-all" approach to heart failure is suboptimal in a time of rising chronic heart failure (HF) cases and advancements in the cellular and molecular understanding of HF
  • Precise therapy based on an individual’s biology is needed to reach those likeliest to benefit
  • Increased focus on biomarker-based precision medicine is causing a paradigm shift in drug development
  • A call-to-action must be sounded to motivate HF specialists to break the inertia of outdated practice patterns and move toward practicing precision medicine and biomarker-based care

Many current heart failure (HF) specialists are transitioning from “one size fits all” cardiac care to personalized medicine that makes use of a patient’s biological information. But to improve outcomes, a further transition must be made from personalized to precision and biomarker-based medicine—because HF is mechanistically diverse.

Imprecision vs. Precision Medicine

The prevailing standard of care can be considered imprecision medicine—the clinical literature abounds with outliers and anomalous cases of patients not benefitting as expected, while others achieve optimal outcomes from the identical protocol. In personalized medicine, a close partnership between physician and patients incorporates individual biological data to formulate a therapy.

Precision medicine goes further. At the core of the concept is the idea that one may identify a biological signal towards which therapies might be applied to specifically counteract pathophysiology. Precision medicine uses computational network knowledge that aggregates and analyzes information from patient cohorts, healthy populations and experimental systems to define disease mechanisms and identify therapies for these mechanisms of HF.

Biomarker-guided Therapy

The promise of precision medicine is underpinned by large-scale biologic databases, omics, diverse cellular assays and digital health technologies. Novel biomarkers and pathways will be discovered, bio-targeting mediators of HF will occur and patients may even be treated per one of seven major classes of biomarkers for HF.

These classes include:

  • oxidative stress
  • neurohumoral activation
  • renal dysfunction
  • inflammation
  • matrix remodeling
  • myocyte injury
  • myocardial stretch

For biomarkers to play a widespread and foundational role in this new realm of HF treatments, there need to be many more rigorous and large-scale trials to test their efficacy.

Call to Action

For the sake of public health and HF patients in particular, now is the time to overcome the inertia of outmoded practice patterns and move from the current (imprecise) medicine model to biomarker-based personalized care. That first step can serve as a precursor toward adoption of full-blown precision medicine with a broad research agenda that spans the spectrum of basic, translational and clinical studies.

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