Clinical Scorecard: Innovative Approaches for Prevention, Prediction, and Management of Heart Failure

At a Glance

Key Highlights

• Differential effects of sodium chloride (harmful) versus sodium bicarbonate (potentially beneficial) on HF pathophysiology and outcomes
• Biomarker-driven risk prediction using plasma proteomics, ketone bodies, and gut microbiome metabolites enhances HF risk stratification
• Pharmacologic advances such as SGLT2 inhibitors reduce HF hospitalizations and mortality, especially in vulnerable populations like cancer patients

Guideline-Based Recommendations

Diagnosis

• Use multi-marker biomarker panels including NT-proBNP, LTBP2, REN, GDF15, ketone bodies, and gut microbiome metabolites for improved HF risk prediction
• Incorporate clinical factors with biomarker data to stratify patients into high- and low-risk groups

Management

• Shift sodium intake recommendations to consider sodium salt structure, limiting sodium chloride while recognizing potential benefits of sodium bicarbonate
• Implement SGLT2 inhibitors in high-risk populations including cancer patients to reduce HF events and mortality
• Prescribe structured exercise training modalities such as high-intensity interval training (HIIT) and combined training (CT) to improve functional capacity
• Incorporate home-based isometric exercise training in HFpEF patients to improve blood pressure and cardiac function

Monitoring & Follow-up

• Monitor thoracic impedance, heart rate variability, and physical activity via cardiac implantable electronic devices to detect transient physiological changes associated with increased HF risk
• Assess biomarker levels periodically to refine risk stratification and guide therapy adjustments

Risks

• Recognize that short-term lifestyle changes, such as during holidays, can transiently increase HF risk
• Be aware of chronotropic incompetence in HFpEF patients which may not improve with standard exercise training, indicating need for alternative interventions

Patient & Prescribing Data

Patients with heart failure including those with chronic kidney disease, cancer survivors, HFpEF patients, and heart transplant recipients

SGLT2 inhibitors significantly reduce HF hospitalizations, new HF diagnoses, and all-cause mortality in cancer patients; exercise training improves functional capacity and cardiac parameters in HFpEF and transplant recipients

Clinical Best Practices

• Adopt integrated, personalized strategies combining biomarker-guided risk assessment and precision pharmacotherapy
• Tailor sodium intake recommendations based on salt type rather than total sodium alone
• Utilize multi-marker biomarker panels including proteomics and metabolic markers for enhanced HF prediction
• Incorporate structured and home-based exercise programs to improve cardiovascular function and patient outcomes
• Monitor device-derived physiological parameters to detect early signs of HF decompensation
• Consider cardioprotective therapies such as SGLT2 inhibitors in vulnerable populations exposed to cardiotoxic treatments

References

• Sadki et al. on sodium salts and heart failure
• Olsson et al. on lifestyle changes and HF risk during holidays
• Zhang et al. on plasma proteomics for HF prediction
• Chevli et al. on ketone bodies in HF risk prediction
• Israr et al. on gut microbiome metabolites and HF risk calculator
• Bhalraam et al. on SGLT2 inhibitors in cancer patients with HF
• Edwards et al. on isometric exercise training in HFpEF
• Nasser et al. on structured exercise training and chronotropic incompetence
• De Lima et al. on exercise training in heart transplant recipients