Optimizing clinical risk stratification in acute heart failure

Heart failure occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. Acute heart failure is defined as a rapid onset of signs and symptoms of heart failure resulting in the need for urgent medical treatment. Acute heart failure is associated with survival poorer than many forms of cancer and is an enormous burden to health care systems mainly related to the high rate of readmissions. Identification of patients who do well after hospitalization and those who have high risk for death or hospital readmission is paramount to personalize treatment and intensity of post-discharge monitoring. However, contemporary instruments used to stratify patients into different risk categories are inadequate and there remains an unmet need for improved risk stratification tools.
In this thesis, Dr. Demissei has provided important tools to improve the prediction of patients that have high risk of poor clinical outcome. His thesis showed that multiple markers, instead of using single markers, improved the accuracy of prediction of major future problems. His research also showed that more accurate risk stratification instruments could help to improve the identification of subgroups of patients who do/do not benefit from a specific drug treatment. This is a first step towards personalized medicine, where only patients that benefit will receive the drug. Future research is needed to study whether risk-guided treatment and monitoring strategies improve survival and reduce the huge burden of hospital readmissions in acute heart failure patients.