title: Practical Pharmacogenomic Approaches to Heart Failure Therapeutics.
abstract: The major challenge in applying pharmacogenomics to everyday clinical practice in heart failure (HF) is based on (1) a lack of robust clinical evidence for the differential utilization of neurohormonal antagonists in the management of HF in different subgroups, (2) inconsistent results regarding appropriate subgroups that may potentially benefit from an alternative strategy based on pharmacogenomic analyses, and (3) a lack of clinical trials that focused on testing gene-guided treatment in HF. To date, all pharmacogenomic analyses in HF have been conducted as post hoc retrospective analyses of clinical trial data or of observational patient series studies. This is in direct contrast with the guideline-directed HF therapies that have demonstrated their safety and efficacy in the absence of pharmacogenomic guidance. Therefore, the future of clinical applications of pharmacogenomic testing will largely depend on our ability to incorporate gene-drug interactions into the prescribing process, requiring that preemptive and cost-effective testing be paired with decision-support tools in a value-based care approach.
authors: Department of Cardiovascular Medicine, Heart and Vascular Institute, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
authors: Chayakrit
authors: C
authors: Krittanawong
authors: Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA.
authors: Amalia
authors: A
authors: Namath
authors: Advanced Heart Failure and Cardiac Transplantation, Research Scientist, Center for Health Services Research, Henry Ford Hospital, Detroit, MI, USA.
authors: David E
authors: DE
authors: Lanfear
authors: Department of Cardiovascular Medicine, Heart and Vascular Institute, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA. tangw@ccf.org.|Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA. tangw@ccf.org.
authors: W H Wilson
authors: WH
authors: Tang
keywords: Genetic variants; Heart failure; Pharmacogenomics; Polymorphism; Precision medicine