A Review of the Improvement in Diagnostic Accuracy for Acute Heart Failure (INDICATE-HF)

Abstract

The aim of the current study is to unearth a diagnostic model to improve the ruling-in of heart failure, rather than ruling out. The process of heart failure diagnosis is imperative to prevent recurring hospitalization. Through observation of previous approaches, it was determined that an improved clinical procedure to distinguishing heart failure could be achieved by including a multiple circulating biomarker proposal for the different pathophysiological pathways associated with heart failure. This advancement was done through proteomics and blood work assays, which would potentially achieve a multi-marker model to be carried out rapidly in the ED to rule-in heart failure with an increased accuracy. In a study sponsored by Vanderbilt University, the clinical research continues to be carried out in 4 EDs between Nashville, Tennessee and Detroit, Michigan. The title of the study is “Improving Diagnostic Accuracy for Acute Heart Failure” (INDICATE-HF), and is currently conducted at Vanderbilt University Medical Center, Detroit Medical Center (DMC) Sinai-Grace Hospital, DMC Detroit Receiving Hospital, and DMC Harper University Hospital. After approaching patients that fit the inclusion/exclusion criteria, mainly dyspnea (shortness of breath), they were asked for voluntary admission into the study for further proteomic testing. Blood and urine samples were taken, and lab work was carried out for further testing of trends in various biomarkers associated with the pathology of the disease. Prior studies, although few, have been conducted to deduce a multi-biomarker approach to identify heart failure in patients presenting to the ED with dyspnea. These studies have possessed limitations that include highly correlated markers from known biological pathways1, which create discrepancies in determination of elevated proteins correlated with heart failure or some other pathology. The current mode of diagnosis revolves around a pair of biomarkers, B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP), which has a detailed physiology within the body, but is limited in capacity for elucidation of heart failure because of the diversity of the syndrome and presentation in the ED. The current hypothesis of the study is a hope of elucidating a multi-marker panel incorporating novel proteins discovered with plasma proteomics, which has the potential to improve diagnostic accuracy for acute heart failure. There have been many studies carried out, including those on myocardial injury and ischemic stroke, that transitioned from a single biomarker to a multi-marker panel, which allowed for a more accurate diagnosis of these various pathologies. The current review will provide an understanding of the pathology of heart failure, the current mode of diagnosis, and the potential of incorporating a panel of biomarkers for improved accuracy of ruling-in heart failure. These supporting studies argue for a promise of better outcomes in the diagnosis and could potentially reduce adverse outcomes as they pertain to heart failure.