Insights and Opportunities from Multimarker Evaluation of Heart Failure: Lessons from BIOSTAT-HF.

Purpose of review: Heart failure is a complex and heterogenous disease state that affects millions worldwide. Over recent decades, advancements in medical therapy and device implementation have significantly transformed the landscape of heart failure outcomes, while improvements in imaging modalities and greater accessibility to genome sequencing have led to increasing recognition of distinct heart failure endotypes. There is rising evidence to suggest all patients do not benefit equally from intensification of guideline directed medical therapy (GDMT). Efforts to personalize medical therapy to maximize benefits while minimizing side effects remains an ongoing challenge. We review key manuscripts from The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), a multicenter observational study conducted across Europe, which prospectively enrolled patients with acute or worsening heart failure.

Findings: BIOSTAT-CHF was designed to characterize biological pathways associated with varied patient responses to GDMT for heart failure. Utilizing a diverse cohort of European patients, the authors were able to develop risk models to predict mortality and heart failure hospitalization from clinically available data plus standard and novel biomarkers. They also utilized modeling to refine characterization of heart failure subtypes and personalization of GDMT titration. In this review we highlight key insights from the BIOSTAT-CHF cohort and how they relate to: (1) prognosis and monitoring treatment response in heart failure, (2) personalization of heart failure treatment, and (3) elucidation of biological pathways and future directions for research. These insights summarize how BIOSTAT-CHF has contributed to a deeper understanding of heart failure, focusing on using biomarkers personalizing treatment approaches, with a goal of ultimately improving patient outcomes.