Prognostic markers for acute heart failure.

Introduction: Acute heart failure (AHF) is the leading cause of hospitalization in patients over 65 years, representing a heterogenic syndrome and a major burden, as it is associated with elevated health expenditures and high rates of mortality and readmission.

Areas covered: This article provides a review of individual markers for risk stratification, including clinical, cardiorenal, hemodynamic, neurohormonal and cardiac biomarkers. In addition, aspects as complementary value, monitoring, risk models and events prediction are analyzed.

Expert opinion: In clinical practice, risk stratification of AHF is complex and relies on the integration of bedside evaluation and laboratory biomarkers. Measures of congestion and perfusion, renal function, natriuretic peptides and cardiac troponins have become standard risk markers of death and/or readmission. However, there are numerous research findings that do not translate into an improved clinical management of individuals and a reduction of health costs. Research on this field needs to be redirected in a prospective manner in order to evaluate risk models in the emergency department. This would allow safe identification of patients at lower risk - who could be transferred and managed in out-patient facilities - as well as those biomarkers that, by reflecting pathophysiological routes, could be used as a guide to related therapeutics for improving outcomes. In addition, the identification of specific markers and models closely related with the risk of recurrent AHF is mandatory. Consequently, it is the time for clinicians working in networks to assume a leading role in translating risk assessment in AHF into clinical practice.