Novel endotypes in heart failure: effects on guideline-directed medical therapy
Key result
Biomarker-derived HFrEF endotype 4 linked to ~40% greater risk of mortality or HF hospitalization.
- HR 1.4
- 95% CI 1.1-1.8
- n=2,615
Why the study?
Distinct subtypes of HFrEF patients with different clinical profiles and treatment responses based on biomarker profiles were not well characterized.
Does the response to uptitration of guideline-directed medical therapy differ across biomarker-derived endotypes in patients with HFrEF?
Population
1802 HFrEF patients from BIOSTAT-CHF and 813 in independent validation cohort
Comparison
Uptitration of guideline-directed medical therapy across six biomarker-derived endotypes
Design
Unsupervised cluster analysis in cohort study with validation
Authors
Discussion
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Member takes
Implication
Biomarker-derived endotypes may enable personalized HFrEF therapy; extends clustering methods to treatment-response prediction.
Study Design
Type
Cohort (n=2,615)
Structured PICO
Does the response to uptitration of guideline-directed medical therapy differ across biomarker-derived endotypes in patients with HFrEF?
P
Population
2,615 patients with heart failure and reduced ejection fraction (1,802 in derivation and 813 in validation cohorts) analyzed to identify biomarker-based endotypes.
E
Exposure
Uptitration of guideline-directed medical therapy (ACEi/ARB and beta-blockers)
C
Comparator
Different biomarker-derived endotypes (1 through 6)
O
Outcome
Composite of all-cause mortality or hospitalization for heart failurecomposite
Main Result
Hazard Ratio: 1.4 (95% CI 1.1–1.8)
Biomarker-based endotyping in HFrEF identifies distinct patient subgroups with varying risks of adverse outcomes and differential responses to uptitration of guideline-directed medical therapy.
Cite This Study
Tromp et al. (2018) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=2,615). Biomarker-based endotypes (Endotype 4) vs. Other endotypes was evaluated on All-cause mortality or hospitalization for HF (HR 1.4, 95% CI 1.1-1.8). Biomarker-based cluster analysis identified six distinct HFrEF endotypes, with endotype 4 having the highest risk for all-cause mortality or HF hospitalization (HR 1.4; 95% CI 1.1-1.8).