A guide to a custom-tailored era of heart failure treatment

The future of heart failure treatment lies in what's known as precision medicine, according to a new report that seeks to guide doctors along this medical frontier.

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen. Precision medicine looks at individual variations in genetics, metabolism and other factors to provide tailored treatment.

Such an approach could identify people more likely to develop heart failure and pinpoint which medications and other therapies could be most effective. The report describes how variations in genes, biomarkers in the blood, or bacteria in the gut can predict the risk of heart failure and how a person may respond to treatments.

The guidance was published Thursday as an American Heart Association scientific statement in the journal Circulation: Genomic and Precision Medicine.

More than 6.5 million people in the United States have heart failure; 1 million new cases are diagnosed annually, according to the statement.

Doctors already use some aspects of precision medicine routinely. For example, the blood level of a biomarker called B-type natriuretic peptide indicates whether heart failure is worsening or if treatments are working. It also can help determine whether symptoms such as shortness of breath are because of heart failure or something else.

"The use of biomarkers is probably the most advanced aspect of precision medicine currently used in the treatment of heart failure," Dr. Sharon Cresci, chair of the statement writing group, said in a news release. She is associate professor of medicine and genetics at Washington University in St. Louis. "Most others are still in their infancy, and we hope in the future to combine multiple aspects of precision medicine to improve patient care and outcomes."

Medications have improved the prognosis for people with heart failure in recent decades. Cresci explained, "Major clinical trials often treat large numbers of patients with one medication, and if there is a positive result, the use of that medication is likely to be incorporated into guidelines for treatment."

But the one-size-fits-all approach has limits. Cresci said that within a large group of clinical trial participants, some people often show no response or suffer side effects. "Precision medicine approaches can help us identify who those non-responders or adverse responders are likely to be so we can find different treatment options for them," she said.

To do this, it is important that clinical trials enroll a diverse group of participants, she said. "People with different racial and ethnic ancestry have different genetic variants. Therefore, they may not have the same response to a medication or other treatment."

The promise of precision medicine also hinges on infrastructure, Cresci said. "We'll need specialized training for clinicians, processes for sharing information across large databases and guarantees for patient privacy."

Nevertheless, she added, "It's exciting to realize the potential lifesaving innovations on the horizon through precision medicine."