Emerging practice of precision medicine could one day improve care for many heart failure patients

September 12, 2019

DALLAS, Sept. 12, 2019 -- The emerging practice of precision medicine could one day personalize heart failure care by identifying groups of patients more likely to develop heart failure and tailoring which medications and other therapies could be most effective for them, according to a new scientific statement from the American Heart Association, published in the journal Circulation: Genomic and Precision Medicine.

Precision medicine uses information about a person's genetic make-up, metabolism and other biological and environmental factors to determine what strategies can better prevent or treat a health condition. The goal is to provide personalized treatment that is more likely to be successful for each individual patient, rather than a one-size-fits-all approach.

This new American Heart Association statement provides a state-of-the-science overview of heart failure as it relates to the different aspects of precision medicine, including 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 various treatments.

"We aim to improve care for everyone with heart failure by more clearly defining the best treatment options for specific groups of people," said Sharon Cresci, M.D., chair of the statement writing group and associate professor of medicine and genetics at Washington University in St. Louis, Missouri. "This statement details the potential of precision medicine to improve patient outcomes."

The prognosis for people with heart failure has improved in recent decades as research studies have demonstrated the effectiveness of various medications. However, within those clinical trial populations are groups of people who are less likely to benefit from the drug and some who may have serious side effects.

"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," Cresci said. "Yet, within the large group of clinical trial participants, there are often some with no response and some with an adverse response. 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."

To do this, it is important that clinical trials enroll a diverse group of participants, according to Cresci.

"Historically, clinical trial participants have been predominantly white people with particular genetic variants. 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," she said. "Researchers conducting clinical trials recognize this issue and are trying to increase diversity among clinical trial participants so we can find the optimal treatment approaches for each population group."

Some aspects of precision medicine are already routinely used by healthcare providers treating heart failure. For example, the blood level of a biomarker called B-type natriuretic peptide is a sensitive indicator of whether heart failure is worsening or if treatments are helping. It can also help determine whether symptoms such as shortness of breath are due to heart failure rather than another medical problem.

"The use of biomarkers is probably the most advanced aspect of precision medicine currently used in the treatment of heart failure. 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," Cresci said.

Because health professionals may be unfamiliar with one or more precision medicine approaches, the statement aims to be an educational resource by combining information on how each applies to heart failure.

"This statement also outlines how advances in technology have and can be used to precisely define variability within population groups, and how these advances can be applied to specific patients with heart failure," said Naveen L. Pereira, M.D., vice-chair of the scientific statement writing committee and professor of medicine and associate professor of pharmacology at the Mayo Clinic College of Medicine in Rochester, Minnesota. "A composite of results from these various precision medicine techniques may also allow us to identify previously undiscovered biology that could lead to the discovery of new medications and treatments for people with heart failure."

Recognizing the value of this multi-faceted and personalized approach to heart disease, the American Heart Association established the Institute for Precision Cardiovascular Medicine in 2015. It provides:"The field of precision medicine is still in its infancy, with infrastructure and programs to be built. We'll need specialized training for clinicians, processes for sharing information across large databases and guarantees for patient privacy," Cresci said. "It's exciting to realize the potential life-saving innovations on the horizon through precision medicine."
Co-authors are: Ferhaan Ahmad, M.D., Ph.D.; Mirnela Byku, M.D., Ph.D.; Lisa de las Fuentes, M.D.; David E. Lanfear, M.D.; Carolyn M. Reilly, Ph.D., R.N.; Anjali T. Owens, M.D.; and Matthew J. Wolf, M.D., Ph.D., on behalf of the American Heart Association's Council on Genomic and Precision Medicine, Council on Cardiovascular and Stroke Nursing and Council on Quality of Care and Outcomes Research. Author disclosures are in the manuscript.

Additional Resources:

Available multimedia is on the right column of the release link - https://newsroom.heart.org/news/emerging-practice-of-precision-medicine-could-one-day-improve-care-for-many-heart-failure-patients?preview=af08ffd06fa175d61e9272d79411517c

After Sept. 12 embargo, view the manuscript online.

Learn more about heart failure

Precision medicine platform now open for collaborative discovery about cardiovascular diseases

Growing cardiovascular genetics field calls for special multidisciplinary clinical programs to better identify and treat inherited heart conditions

Follow AHA/ASA news on Twitter @HeartNews

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.