Variations on a Precision Medicine Theme: One Size Fits Some.

Abstract

Precision medicine, or personalized medicine, refers to the tailoring of therapy to the individual characteristics of patients. It can be applicable to patients with advanced disease and to preventative interventions as well. The impetus for this approach came from sequencing of the human genome and the anticipation that an individual’s sequence would inform treatment, aided perhaps by Big Data algorithms. In heart failure, advances in omics have occurred alongside other disciplines but from a practical standpoint, our ability to provide precision medicine remains more or less in the neutral position. In this article, we maintain that despite significant limitations on our ability to use genotyping or Big Data to impact real-world heart failure care in real time, we are in fact practicing a significant degree of precision medicine and can continue to do more of the same with relatively modest changes in approach to practice. The advent of angiotensin-converting enzyme inhibitors and β-blockers impacted heart failure therapeutics1,2 in a truly revolutionary way. They are recommended across all New York Heart Association classes for the management of patients with heart failure with reduced ejection fraction (EF).3 Although β-blockers have not been critically examined in patients with class I symptoms, we accept the notion that for these 2 classes of drugs, one size truly does fit all. We argue about dose, not whether we should use the drugs.4,5 We can also debate the duration of treatment in patients who have normalized their EF and the likelihood of recurrence of heart failure if those medications are stopped. Fundamentally, the importance of blockade of the renin–angiotensin system and adrenergic stimulation are fully accepted concepts that apply in young and old, symptomatic and asymptomatic, borderline low and very low EF, left ventricular failure and biventricular failure, in the …