Page 164 - Biomarkers for risk stratification and guidance in heart failure

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fixed recommended dosages being the cornerstone of treatment.67,73 However, it can be argued if such a generalized treatment of HF is the best way to treat individual HF patients. As stated earlier in this discussion, real-life HF population differs from the landmark trials on which guidelines have been based, including mostly younger patients with no or little comorbidities. It is generally known that in real life, especially in the elderly, evidence based dosages of HF medication is only achieved in a minority of patients, partly due to (i) multiple comorbidities, (ii) side effects of HF medication, (iii) negative effects of polypharmacy among which increased risk of toxicity, drug interactions and poor compliance.97
Additionally, several studies have suggested that tolerability and possibly
also effects of HF medication might vary significantly between patients. Studies 7 assessing the effect of genetic polymorphism have demonstrated differences
in effect of beta-blockers, ACE-inhibitors and diuretics, however there is still no
evidence that tailoring therapy according to polymorphisms for beta-blockers
and ACE-inhibitors is effective.98
Furthermore, as etiology of HF is quite diverse, it might be argued that specific etiological background should lead to specific HF therapy.
These findings have led to increased interest in personalized medicine for HF, defined as identifying patients most likely to benefit and those most likely to experience adverse reactions in response to specific drugs, and tailoring therapy based on this knowledge. Implementing such personalized therapy strategy in heart failure might lead to (i) more effective therapy by only prescribing drugs that
Figure 3. Number of publications per year for Biomarkers in Heart Failure. Source: www.pubmed.gov. Keywords: "Biomarkers Heart Failure".
General Discussion
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