Toward Personalized Heart Failure Management: Integrating Biomarkers and Multimodal Monitoring Strategies

Effective heart failure (HF) management requires timely recognition and treatment of congestion in both inpatient and outpatient settings. As the complexity of HF care increases, there is a growing interest in improved guided therapy strategies, including both biomarker-driven approaches and non-invasive and invasive remote monitoring. While natriuretic peptides remain the cornerstone of biomarker-based prognostication, emerging biomarkers reflecting diverse pathophysiological processes, such as myocardial stress, fibrosis, and inflammation, offer potential for enhanced risk stratification, particularly when used in serial multimarker panels. Despite their prognostic value, biomarkers are not yet routinely employed in guided therapy. Additionally with the increasing availability hemodynamic remote monitoring strategies and devices, we could learn more about pathophysiological processes, multi-biomarker panels and their relation to congestion and risks for progression of HF which can help to further refine biomarker-guided therapy. This review evaluates the potential use of biomarkers in guided therapy for HF and explores the rationale for their integration into multimodal monitoring frameworks aiming for a more personalized and dynamic model of HF care, in which different monitoring approaches can reinforce each other.