Biomarkers of Risk Stratification in Congestive Heart Failure: North American View

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.

KEYWORDS::

• biomarkers
• heart failure
• natriuretic peptide
• risk stratification
• troponin

Financial & competing interests disclosure

The author has no 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. 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.