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Canadian Journal of Cardiology

A Novel Approach to Drug Development in Heart Failure: Towards Personalized Medicine

Published:December 19, 2013DOI:https://doi.org/10.1016/j.cjca.2013.12.005

      Abstract

      Evidence-based treatment has succeeded in improving clinical outcomes in heart failure. Nevertheless, morbidity, mortality, and the economic burden associated with the syndrome remain unsatisfactorily high. Most landmark heart failure studies included broad study populations, and thus current recommendations dictate standardized, universal therapy. While most patients included in recent trials benefit from this background treatment, exceeding this already significant gain has proven to be a challenge. The early identification of responders and nonresponders to treatment could result in improved therapeutic effectiveness, while reduction of unnecessary exposure may limit harmful and unpleasant side effects. In this review, we examine the potential value of currently available information on differential responses to heart failure therapy—a first step toward personalized medicine in the management of heart failure.

      Résumé

      Le traitement fondé sur des données probantes est parvenu à améliorer les résultats cliniques de l’insuffisance cardiaque. Néanmoins, la morbidité, la mortalité et le fardeau économique associés au syndrome demeurent trop élevés. Les études les plus marquantes sur l’insuffisance cardiaque incluaient de vastes populations, donc les recommandations actuelles dictent un traitement universel standardisé. Bien que la plupart des patients inclus dans les récents essais bénéficient de ce traitement de fond, le dépassement de ce gain déjà significatif s’est révélé difficile. L’identification précoce des patients qui répondent au traitement et de ceux qui n’y répondent pas permettrait d’améliorer l’efficacité thérapeutique, alors que la diminution de l’exposition inutile pourrait limiter les effets secondaires néfastes et désagréables. Dans cette revue, nous examinons la valeur potentielle des informations actuellement disponibles sur les effets différentiels du traitement de l’insuffisance cardiaque, une première étape vers la médecine personnalisée utile à la prise en charge de l’insuffisance cardiaque.
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