Tracking the evolution of heart failure patient risk assessment

Blog Posts  |  31 July 2020  |  By Tom Pasquariello, PharmD, BCPS, BCMAS, PMSP

Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out during each contraction. Roughly half of all patients with heart failure have a normal EF (≥50%) despite impaired heart function - this syndrome is known as heart failure with preserved ejection fraction (HFpEF). HFpEF rates continue to rise, particularly in more developed countries, due to common risk factors such as older age, female gender, hypertension (80-90% of patients), metabolic syndrome, renal dysfunction, and obesity.1

For more information on how Veradigm combined capabilities from across our portfolio to advance clinical knowledge on this issue from several different perspectives, please view our whitepaper titled Heart Failure with Preserved Ejection Fraction (HFpEF): Emerging Pharmacotherapies.

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One observational study, measured in young adults age 18-30, showed two biomarkers linked to endothelial activation that may predict subclinical myocardial changes in middle age that later develop HFpEF.2 The study, published in the Journal of the American College of Cardiology, showed that elevations in cellular adhesion molecules E-selectin and ICAM-1 are inflammatory biomarkers for existing HFpEF. Important to note is that these biomarkers were strongly associated at a very young age unassociated with clinical morbidities that accumulate over time such as diabetes, hypertension, and obesity.1

It’s critical to note that the science around genetics and genomics, such as that outlined in the example above, is a rapidly evolving field. New genetic variations are being identified and explained at an unprecedented rate, and various molecular labs offer testing to help providers (and patients themselves, through direct-to-consumer offerings) arrive at more precise diagnoses and select targeted therapies based on the individual’s genetic profile.

2bPrecise, an enterprise-spanning precision health platform, works with providers to make genetic/genomic test results available within their familiar workflow. Point-of-care access to germline data – for conditions like cardiomyopathy and countless others – enables providers to treat patients sooner and more effectively. Pedigree tools can help clinicians identify patient at greatest risk for heritable conditions so they can be referred for genetic testing. Likewise, once a condition has been diagnosed, findings from genetic testing can be used to ensure the medications selected are the best option for the patient. 2bPrecise pharmacogenomics capabilities, for example, give clinicians one-click access to a dashboard revealing how well – or poorly – a patient metabolizes a specific medication. With this insight, the provider can be sure to prescribe the most effective treatment immediately upon diagnosis, rather than undertaking the traditional trial-and-error approach that delays positive response.

As part of this same effort to improve care for heart failure patients, Veradigm has partnered with the American College of Cardiology to help improve cardiac care in the U.S. We are now operating the PINNACLE Registry® (which focuses on coronary artery disease, hypertension, heart failure, atrial fibrillation and diabetes in the outpatient setting) in association with the College and leveraging data from the registry to power real-world research. Further, we are working to utilize our technologies and provider network to bring the best practices, most up to date guidelines, and policies developed by the college to physicians at the point of care. By doing so, Veradigm is helping to bring innovative therapies and new treatments to patients quickly and provide a positive impact on healthcare for patients from the point of care to everyday life.


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