Active screening of patients with type 2 diabetes or chronic obstructive pulmonary disease (COPD) more than doubled new diagnoses of cardiovascular disease compared with usual care, according to results from the RED-CVD trial presented at ESC Congress 2023.

The trial included 1,216 patients, of whom were approximately 68 years of age, 87% had type 2 diabetes, 40% were women and 20% had COPD. Participants were assigned to 25 primary care practices across the Netherlands that were randomly allocated to provide routine care (control group) or to add an early diagnosis strategy to their usual disease-management programs for type 2 diabetes and COPD (intervention group).

The intervention involved three steps:

1. A questionnaire on risk factors and symptoms that was filled out at home prior to the next routine visit to a type 2 diabetes or COPD management program.
2. Patients who scored above a prespecified threshold on the questionnaire then underwent a physical examination by the practice nurse during a routine visit that involved looking for signs of heart failure (HF), 12-lead electrocardiography (ECG) and NT-proBNP measurements.
3. The GP interpreted Steps 1 and 2 results and referred patients to a cardiologist or open access echocardiography if deemed necessary.

The primary outcome was a composite of newly detected cases of HF, atrial fibrillation (AFib) and coronary artery disease (CAD) at one year after baseline visit. Secondary endpoints included newly initiated treatments at one year after the baseline visit.

At one year, 50 of 624 patients in the intervention group and 19 of 592 patients in the control group were newly diagnosed with at least one of the following: HF, AFib or CAD. Researchers noted that HF was the most common new diagnosis (4.5%) in the intervention group, followed by CAD (2.6%) and AFib (2.1%). These percentages were more than double those of the control group. No major differences in medication use at follow-up were observed between the intervention and control groups.

"An easy-to-implement strategy more than doubled the number of new diagnoses of HF, AFib and CAD in high-risk patients," said Amy Groenewegen, MD, of the University Medical Centre Utrecht, the Netherlands. "Because there are so many adults in the community with COPD or type 2 diabetes, this approach could translate into tens of thousands of new diagnoses when applied at large. In the Netherlands, for example, screening the more than 920,000 patients with COPD and/or type 2 diabetes could identify over 44,000 patients with at least one previously undiagnosed cardiovascular condition."

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: ESC Congress, ESC23, ACC International, Pulmonary Disease, Chronic Obstructive

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