Risk Stratification Towards Precision Medicine in Heart Failure　― Current Progress and Future Perspectives

• Published in: Circulation Journal Vol. 85; no. 5; pp. 576 - 583
• Main Authors: Nagai, Toshiyuki, Nakao, Motoki, Anzai, Toshihisa
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 23.04.2021
• Subjects: Biomarkers; Forecasting; Heart Failure - therapy; Humans; Omics; Phenotyping; Precision Medicine; Prediction model; Risk Assessment; Risk stratification; Precision medicine; Omics; Phenotyping; Prediction model; Risk stratification
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-1299

Clinical risk stratification is a key strategy used to identify low- and high-risk subjects to optimize the management, ranging from pharmacological treatment to palliative care, of patients with heart failure (HF). Using statistical modeling techniques, many HF risk prediction models that combine predictors to assess the risk of specific endpoints, including death or worsening HF, have been developed. However, most risk prediction models have not been well-integrated into the clinical setting because of their inadequacy and diverse predictive performance. To improve the performance of such models, several factors, including optimal sampling and biomarkers, need to be considered when deriving the models; however, given the large heterogeneity of HF, the currently advocated one-size-fits-all approach is not appropriate for every patient. Recent advances in techniques to analyze biological “omics” information could allow for the development of a personalized medicine platform, and there is growing awareness that an integrated approach based on the concept of system biology may be an excessively naïve view of the multiple contributors and complexity of an individual’s HF phenotype. This review article describes the progress in risk stratification strategies and perspectives of emerging precision medicine in the field of HF management.