Reconciling evidence-based and personalized medicine: perspectives in heart failure and cardiomyopathies

In the modern era of cardiovascular medicine, clinicians and researchers stand at a pivotal crossroads between the paradigms of evidence-based medicine (EBM) and personalized medicine (PM). This tension is particularly palpable in the management of heart failure (HF) and inherited cardiomyopathies, heterogeneous conditions with complex pathophysiology and variable individual trajectories. While EBM has shaped practice through robust clinical trials and guideline-directed therapies, PM challenges us to consider the uniqueness of the patient beyond population averages. This dilemma is clear when considering that EBM is extensive and robust in the field of HF, instead, high-quality evidence remains relatively scarce for inherited cardiomyopathies, which may often result in HF, further highlighting the critical role of PM in this domain. The divergence underscores a critical epistemological and practical issue: how can clinicians reconcile the generalizability of EBM with the specificity demanded by PM? This review critically examines the philosophical foundations and clinical implications of this paradigm interplay, with a focus on HF and cardiomyopathies. It explores emerging strategies that aim to bridge the gap between standardized care and individualized management. Finally, it proposes a conceptual framework for harmonizing EBM and PM, advocating for a dynamic, context-sensitive approach that leverages the strengths of both paradigms to optimize patient outcomes in an era of personalized cardiovascular care.