Biomarker guided therapy for heart failure: focus on natriuretic peptides.
The management of heart failure remains challenging despite many therapeutic advances. Rigorous clinical trial evidence supports administration of multiple therapies, but utilization of evidence-based treatment remains inconsistent and suboptimal. Disease management programs appear effective, but remain costly and difficult to implement in today's care system. Another approach involves optimizing therapy based on serial monitoring of cardiac biomarkers. Emerging results suggest that guiding therapy based on serial changes in natriuretic peptides may be an effective strategy. Although pilot work has provided encouraging results, appropriately designed, large-scale, prospective randomized trials are needed to confirm these preliminary findings and definitively establish this therapeutic approach.
Department of Medicine, School of Medicine, UNC Heart Failure Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA. kfa@med.unc.edu
Kirkwood F
KF
Adams
G Michael
GM
Felker
Ghassan
G
Fraij
J Herbert
JH
Patterson
Christopher M
CM
O'Connor
D019540:Area Under Curve; D015415:Biomarkers; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods*; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D020097:Natriuretic Peptide, Brain; D045265:Natriuretic Peptides; D011379:Prognosis; D016896:Treatment Outcome; D014336:Troponin
D015415:Biomarkers; D002316:Cardiotonic Agents; D045265:Natriuretic Peptides; D014336:Troponin; D020097:Natriuretic Peptide, Brain