Key result
Serial biomarker testing improves risk prediction for adverse HF outcomes, reaching a 0.83 AUC.
Why the study?
Studies on multiple serially measured blood biomarkers and adverse outcomes in heart failure are scarce and restricted to research settings, leaving the predictive ability of routine serial measurements in real-world HF uncertain.
Do serially measured blood biomarkers collected during usual care predict adverse clinical outcomes better than baseline measurements in ambulatory patients with HFrEF and HFmrEF?
Do serially measured blood biomarkers collected during usual care predict adverse clinical outcomes better than baseline measurements in ambulatory patients with HFrEF and HFmrEF?
Serial measurement of routine blood biomarkers extracted from electronic health records significantly improves risk stratification and prediction of adverse events in patients with HFrEF and HFmrEF compared to baseline measurements alone.
Supports serial biomarkers in routine HF care to enhance risk stratification; reinforces consensus on longitudinal over single-timepoint assessment.
Abstract Background Studies on multiple serially measured blood biomarkers and adverse outcomes in patients with heart failure (HF) are scarce and restricted to research settings. Prognostic estimates based on serial measurements could provide a scientifically substantiated, uniform approach to risk stratification and timing of treatment. We use an exploratory and hypothesis-generating approach to assess the predictive ability of serially measured biomarkers, commonly collected during usual care, for adverse events in a real-world population of ambulant patients with HF with reduced ejection fraction (HFrEF) and HF with mildly reduced ejection fraction (HFmrEF). Methods We included ambulatory HFrEF-HFmrEF patients who attended an outpatient hospital visit between 2017 and 2022. Data on blood biomarkers, clinical characteristics and clinical outcome were extracted from electronic health records. Joint modelling was applied to investigate associations between time-varying blood biomarkers and the composite endpoint of mortality, LVAD implantation and heart transplant. Results We included 1353 patients; 66.8% men; median(P25, P75) age 62(51, 71) years. During a median follow-up of 3.30(1.62, 4.65) years, 387(28.6%) experienced the endpoint. Temporal trajectories of 30 blood biomarkers were significantly associated with the endpoint. After correcting for clinical characteristics, associations persisted in multiple-biomarker models for serially measured NT-proBNP, hs-TnT, and CRP, as well as liver biomarkers, kidney biomarkers, and blood count parameters. Serial measurements increased model performance compared to baseline measurements, with AUCs up to 0.83 for multiple-biomarker models. Conclusion Real-life, serially measured laboratory data predict adverse events in an ambulatory HFrEF-HFmrEF population, with good internal model performance. Thus, making use of laboratory values already present in electronic medical records, could inform risk stratification without any extra effort.
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Kok et al. (2026) studied this question. Serially measured biomarkers significantly improved risk prediction for adverse outcomes in heart failure patients, with AUC up to 0.83 for multiple-biomarker models.
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