Biomarkers May Guide Congestive Heart Failure Medication Titration
At 24 months, an estimated 9.8, 1.3, and 12.3 events per 100 treated patients could be prevented by ACE inhibitor/ARB, beta-blocker, and MRA therapy, respectively.
HealthDay News — Using biomarkers to identify patients with heart failure for up-titration of medications may improve mortality and hospitalization rates, according to a study published in the Journal of the American College of Cardiology.
Wouter Ouwerkerk, PhD, from the University of Amsterdam, and colleagues compared clinical outcomes of 2516 patients with worsening heart failure participating in the BIOSTAT-CHF (BIOlogy Study to Tailored Treatment in Chronic Heart Failure) based upon 3 theoretical treatment scenarios: scenario A, in which all patients are up-titrated to >50% of recommended doses; scenario B, in which patients are up-titrated according to a biomarker-based treatment selection; and scenario C, in which no patient is up-titrated to >50% of recommended doses.
The researchers found that for 1802 patients with available biomarker data, estimated death or hospitalization rates were 16%, 16%, and 26%, respectively, in the angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) up-titration scenarios A, B, and C. In the 3 scenarios, rates with beta-blocker and mineralocorticoid receptor antagonist (MRA) up-titration were 23%, 19%, and 24% and 12%, 11%, and 24%, respectively. At 24 months, an estimated 9.8, 1.3, and 12.3 events per 100 treated patients could be prevented by ACE inhibitor/ARB, beta-blocker, and MRA therapy, respectively, if up-titration was successful in all patients. Events prevented were similar if up-titration treatment decision was based on a biomarker-based treatment selection model.
"Up-titrating patients with heart failure based on biomarker values might have resulted in fewer deaths or hospitalizations compared with a hypothetical scenario in which all patients were successfully up-titrated," the authors wrote.
Several authors disclosed financial ties to the pharmaceutical industry.
Ouwerkerk W, Zwinderman AH, Ng LL, et al. Biomarker-guided vs guideline-based treatment of patients with heart failure: results from BIOSTAT-CHF. J Am Coll Card. 2018;71(4):386-398.