Heart failure biomarkers at point-of-care: current utilization and future potential

Abstract

Heart failure (HF) is a prevalent disease that is associated with a high morbidity and mortality; HF is estimated to cost the US healthcare system over US$39 billion annually. Biomarkers have an increasingly important role in achieving management goals through rapid diagnosis and monitoring of disease processes. HF is a target for healthcare cost control measures and quality improvement metrics. In achieving these benchmarks, point-of-care testing, the development of more sensitive assays for traditional biomarkers and determining appropriate applications for novel markers will be essential in meeting these health quality and cost-driven metrics. Point-of-care applications involving biomarkers can be utilized in inpatient, outpatient and emergency department settings to aid in the rapid diagnosis, risk stratification and management of patients presenting with symptoms consistent with HF. In this paper we review current and promising HF biomarkers with an emphasis on point-of-care testing and its implications in the changing healthcare landscape.

Keywords::

• amino terminal pro B-type natriuretic peptide
• B-type natriuretic peptide
• cardiac biomarkers
• heart failure
• point-of-care
• troponin

Financial & competing interests disclosure

R Christenson receives research funding and honoraria from Roche Diagnostics Products and Siemens Healthcare. P Collinson has received honoraria from Siemens Healthcare. C deFilippi has received research funding and honoraria from Roche Diagnostics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The prevalence of heart failure (HF) is increasing worldwide. HF is broadly considered as two major types: systolic dysfunction HF, which is typically a younger cohort that is predominately male and diastolic HF patients, which tend to be older and have substantial comorbidities. Evidence-based therapies are available for management of systolic dysfunction; however, much less evidence exists for effective treatment strategies for diastolic HF patients.

• Point-of-care (POC) testing has approximately one-third of the processing steps required for conventional central laboratory testing. This allows a much faster turnaround for results and can be valuable for improving health and economic outcomes when data are used in real time.

• The biomarkers B-type natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP) were designated as Class I recommendations and Level of Evidence A in recent evidence-based guidelines [1] for use in diagnosis or exclusion of HF and for prognosis; measurement of cardiac troponin is also a Class IA recommendation for additive risk stratification in recent AHA/ACCF HF guidelines. The Biomarkers ST2 and Galectin-3 are listed in the guidelines as Class IIb recommendation for additive risk stratification however, more clinical trials are needed. Atrial natriuretic peptide, endothelin-1 and adrenomedulin measurement are available as their cometabolite surrogates. They along with growth differentiation factor-15 (GDF-15) are promising biomarkers for which evidence is evolving, and they are predicted to contribute information for management of HF patients.

• POC testing devices are available for measurement of BNP, NT-proBNP and cardiac troponin. Use of these assays has demonstrated benefit in health and economic outcomes. For cardiac troponin assays at POC, care must be taken to use a sensitive or high sensitivity assay. POC testing has shown promise for allowing faster, more convenient obtainment of results which may potentially optimize the biomarkers' impact on improving outcomes.

• Biomarkers via measurement at POC offer great promise as an aid to clinicians for early assessment of patients at risk for developing HF in the general population.