A heart failure (HF) screening strategy focused on NT-proBNP identified a large proportion of patients with diabetes who had previously unrecognized but symptomatic HF, according to research published Aug. 19 in JACC.

The TARTAN-HF prospective, unblinded trial randomized 706 participants across West Scotland to either usual care or NT-proBNP screening, with follow-up echocardiography if NT-proBNP was ≥125 pg/mL. Participants (31% women) were aged ≥40 years (median age, 71 years) with type 1 (10%) or type 2 (90%) diabetes and at least one additional HF risk factor. Risk factors included coronary artery disease (CAD), persistent or permanent atrial fibrillation, previous ischemic or embolic stroke, peripheral artery disease, chronic kidney disease (CKD), regular loop diuretic use >30 days, and chronic obstructive pulmonary disease.

Among participants, 26% had two HF risk factors and 10% had three or more. CKD was the most common risk factor (57%), followed by CAD (39%).

About half of screened participants (174/353) had NT-proBNP ≥125 pg/mL and were referred for echocardiography.

Results at nearly 18 months showed that 25% of the screening group and 1% of the usual care group received an HF diagnosis (odds ratio, 58; p<0.001). HFpEF accounted for most diagnoses (93%) and affected 23% of screened participants. The number needed to screen to detect one case of HF at six months was five. The prevalence of HF increased substantially with additional risk factors, with the number needed to screen dropping to two among those with ≥3 HF risk factors.

In the total screening group, SGLT2 inhibitor use increased from 24% to 39%, while no significant change was observed in the usual care arm. Loop diuretic use also increased in the screening group.

Investigators Daniel Taylor-Sweet, MBChB, et al., note that many of the HF cases diagnosed in the screening group were symptomatic. Patients with unrecognized HF, compared with those without, reported significantly impaired health status at baseline (median KCCQ-12 score, 65.6 vs. 89.6). Breathlessness (84%), fatigue (53%) and ankle edema (53%) were the most common symptoms.

The findings suggest targeted NT-proBNP screening may help identify HFpEF earlier in high-risk patients with diabetes, creating an opportunity to initiate available therapies sooner.

"The ever-growing armamentarium of disease-modifying HFpEF treatments and the high prevalence of unrecognized HFpEF detected through targeted screening in TARTAN-HF highlight not only the need for the ongoing discovery of novel preventative and disease-modifying therapies, but also the value of the early detection of disease to enable implementation of existing therapies," conclude Taylor-Sweet and colleagues.