'Great Potential in Precision Medicine' for Heart Failure, AHA Says

Advances in precision medicine for patients with heart failure are likely to have a major impact on treatment and outcomes, according to a statement from the American Heart Association (AHA).

Individualized heart failure pharmacotherapy on the bases of genetic info embedded in the electronic health record (EHR) could have “great potential,” according to the Association.

The goal of precision medicine is to provide a personalized treatment that is more likely to work for a specific patient, rather than an approach for the general population. With precision medicine, medications and therapies can be tailored for what will be most effective for patients at an individual level.

AHA’s goal with the precision medicine statement was to provide an overview of the state of the “omics” — genomics, pharmacogenomics, epigenomics, proteomics, metabolomics and microbiomics — as they relate to the development and progression of heart failure. The organization also wants to consider current and future applications of these data for precision medicine for prevention, diagnosis and therapy.

While studies have demonstrated the effectiveness of certain medications for patients with heart failure, within clinical trial populations there are groups of patients who are less likely to benefit from the drug.

If there is a positive result of a medication used to treat large numbers of patients during a clinical trial, that drug is likely to be incorporated into guidelines for treatment, said Sharon Cresci, M.D., associate professor of medicine and genetics at Washington University. But some patients may experience no response or an adverse response.

“Precision medicine approaches can help us identify who those non-responders or adverse responders are likely to be so we can find different treatment options for them,” Cresci said.

Clinical trials also must have a diverse set of participants — not just white people with particular genetic variants, she said.

“People with different racial and ethnic ancestry have different genetic variants, therefore, they may not have the same response to a medication or other treatment,” Cresci said. “Researchers conducting clinical trials recognize this issue and are trying to increase diversity among clinical trial participants so we can find the optimal treatment approaches for each population group.”

One of the most advanced aspects of precision medicine, which is used routinely by providers, is biomarkers, AHA said. Many others are still in their infancy.

Sequencing technologies allow sequencing of entire genomes and the identification of causative mutations without the need for genetic linkage analysis or identification of candidate genes, the organization said.

Combining all of an individual’s “omic” data into a single profile might be needed to take advantage of the potential for using precision medicine for heart failure, AHA suggested.

Machine-learning techniques could model prediction of outcomes in heart failure. Such techniques, along with artificial intelligence, can make it possible to incorporate multimodal and multidimensional omics with phenotypic data acquired from the EHR and mobile and sensor technology to advance precision medicine.

“(Heart failure) omics have the potential to contribute greatly to advances in precision medicine approaches for these patients,” AHA wrote.

Advances derived from “omic” investigations, including the development and testing of epigenomic therapeutics and identifying new proteomic and metabolomic profiles in patients with heart failure, are pointing toward novel heart failure treatments.

“It’s exciting to realize the potential life-saving innovations on the horizon through precision medicine,” Cresci said.

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