Review of heart failure medications and microbiome insights for individualized treatment strategies

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Frontiers in Medicine Published April 19, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider integrating microbiome insights into HF treatment to support individualized strategies, noting limited evidence.

This narrative review focuses on heart failure management, specifically discussing the roles of digoxin, angiotensin receptor-neprilysin inhibitors, ACE inhibitors, angiotensin receptor blockers, beta-blockers, sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and diuretics. The publication does not report a specific study population, sample size, or setting, as it serves as a synthesis of existing concepts rather than a primary trial.

The authors argue that incorporating microbiome insights into heart failure treatment could facilitate more precise and individualized strategies. This approach aims to help address current therapeutic limitations inherent in standard management protocols. However, the text explicitly states that the evidence remains limited and that certain methods require further refinement to be fully validated.

No specific adverse events, discontinuations, or tolerability data are reported in this review. Consequently, the practice relevance is framed cautiously, suggesting that while these insights are promising, they should be interpreted within the context of ongoing research needs and methodological gaps.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

Heart failure (HF) management remains challenging because patients often show large differences in how well treatments work and in how often adverse drug reactions occur. Traditional pharmacogenomics cannot fully explain these differences. Emerging evidence from pharmacomicrobiomics shows that the gut microbiome represents a previously underappreciated factor influencing drug responses. This review summarizes the two-way interactions between the gut microbiota and key HF drugs, including digoxin, angiotensin receptor-neprilysin inhibitors (ARNIs), ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, sodium-glucose cotransporter 2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists (MRAs), and diuretics. On the one hand, gut microbes can change drug effects because they can metabolize drugs and affect host physiological pathways. On the other hand, HF drugs can change the structure and function of the gut microbial community. This review also discusses how microbiome-related features may serve as biomarkers to support personalized treatment and how strategies such as dietary changes and microbiota-targeted therapies may improve clinical outcomes. Although evidence remains limited, and certain methods require further refinement, integrating microbiome insights into HF treatment may support more precise and individualized treatment strategies and help address current therapeutic limitations.