The role of biomarkers across the care continuum in acute heart failure

Abstract

Acute heart failure (AHF) remains a global health challenge, characterized by high morbidity, mortality, and frequent rehospitalizations. The heterogeneity of clinical presentations in AHF and its complex underlying pathophysiology complicates diagnosis, risk stratification, and therapeutic decision-making. Biomarkers have reshaped the clinical landscape in AHF by providing objective, biologically-grounded insights that complement traditional clinical assessment. Natriuretic peptides are established as indispensable for diagnosis and prognosis, while troponins, soluble ST2, galectin-3, and even newer candidates such as adrenomedullin and CA-125 may capture complementary domains including myocardial injury, fibrosis, congestion, and systemic stress. Applied dynamically across the care continuum—from the emergency department to hospitalization, discharge, and follow-up—biomarkers may support earlier diagnosis, more refined risk assessment, monitoring of therapeutic response, and post-discharge surveillance. Evidence increasingly favors multimarker strategies, integrating diverse biological signals; these consistently outperform single-marker approaches. Risk scores that incorporate biomarkers further strengthen clinical decision-making by providing structured risk estimates at critical time points. Future studies must explore best means of combining multiple markers into panels and whether multimarker-guided strategies have benefit in improving outcomes beyond the natriuretic peptides and troponin. Future advances will depend on embedding biomarkers within precision-medicine frameworks. Phenotype-specific algorithms, integration into electronic health records with automated decision support, and the application of artificial intelligence and machine learning offer clear potential. Equally, innovations in point-of-care testing and remote monitoring may extend biomarker utility beyond hospital walls. Collectively, these developments could shift AHF management from reactive stabilization toward proactive, biomarker-guided care aimed at improving outcomes in this high-risk population.