Bringing a Precision Medicine Approach to Heart Failure

February 29, 2020
Mary Caffrey

Barriers to better treatment start with the basic definitions of heart failure. Classifications in use for decades, such as the New York Heart Association system or the left ventricle ejection fraction measure, need an overhaul, and the field should take a precision medicine approach that brings analytics and biomarkers to the cause.

Heart failure (HF) is among the most expensive conditions in healthcare; medical costs alone are projected to reach $53 billion by 2030. As Medicare has shifted to value-based reimbursement models, HF has topped the list of conditions that hospitals must address, because failing to halt the repeat readmissions that define this disease will affect their bottom line.

But as Yale Medicine researchers Nihar Desai, MD, MPH, and Tariq Ahmad, MD, MPH, FACC, told Yale News this week, the barriers to better treatment start with the basic definitions of HF. Classifications in use for decades, such as the New York Heart Association system or the left ventricle ejection fraction (LVEF) measure, need an overhaul, and the field should take a precision medicine approach that brings analytics and biomarkers to the cause.

Desai pointed to the pair’s editorial in the Journal of the American College of Cardiology, which explored the findings of the BIOSTAT-CHF project (BIOlogy Study to TAilored Treatment in Chronic Heart Failure). That study uncovered key biomarkers but more importantly identified distinct subgroups of HF, including 8 specific to reduced ejection fraction (HFrEF) and 6 for preserved (HFpEF).

Just as cancer is not one disease, but many, so is the case with HF—and a precision medicine approach must follow. “This study shows us that the molecular pathways underlying clinically identified subgroups of the syndrome have the potential to give us novel insights into disease process and therapeutic strategies,” the authors wrote.

Indeed, in the recent issue of JACC: Heart Failure, researchers led by Jordana B. Cohen, MD, MSCE, found distinct responses to spironolactone, a water pill, across 3 clinical phenogroups with HFpEF that could be tracked with biomarkers.

Desai and Ahmad were authors on an editorial on this study, and they encouraged more work in this area in their interview.

“We must move beyond these outdated definitions and bring precision medicine to patients with heart failure,” Desai told the Yale News. “We need an intelligent, evolving healthcare system in which research and care delivery are integrated—and advanced analytics, along with state-of-the-art biomarker testing, are able to continually augment our ability to make personalized decisions for individual patients.”