Identifying Reliable Biomarkers for Pulmonary Congestion: Toward a Close Yet Sustainable Heart Failure Follow-Up

This article refers to ‘Serial cardiac biomarkers, pulmonary artery pressures and traditional parameters of fluid status in relation to prognosis in patients with chronic heart failure: Design and rationale of the BioMEMS study’ by Y. Allach et al., published in this issue on pages 1736–1744. Heart failure (HF) affects over 64 million people worldwide, and its burden is expected to increase over the next few years.1 Hospital admissions due to HF not only impact the patients' quality of life and prognosis, but also impose a great burden on healthcare systems. Early detection of impending decompensation may allow for changes in therapeutic strategy and potentially prevent a hospitalization due to worsening HF.2 Haemodynamic congestion is a primary cause of HF hospitalizations, underscoring the need for reliable markers of congestion. The biomarkers used in clinical practice are B-type natriuretic peptides (NPs), which have several limitations. First, several comorbidities (i.e. atrial fibrillation, chronic kidney disease, and obesity) may affect NP values regardless of congestion status.3 Second, measurement intervals during follow-up have not been standardized and typically range from 6 to 12 months. Third, no validated protocols for therapy adjustment based on NP changes exist because of the little evidence on the prognostic efficacy of treatment strategies guided by NP values.4