Screening program flags unrecognized heart failure in patients with diabetes
Using N-terminal pro–B-type natriuretic peptide (NT-proBNP) testing kits to screen patients with diabetes is an effective way to find patients with unrecognized heart failure (HF) and get them started on key medications. That’s the key takeaway from a new study published in JACC, the flagship journal of the American College of Cardiology.[1]
“Strategies to identify patients at risk of the development of HF have been suggested, incorporating circulating biomarkers of cardiac stress (natriuretic peptides) and myocardial injury (cardiac troponins),” wrote first author Dr. Daniel Taylor-Sweet, a researcher with the School of Cardiovascular and Metabolic Health at the University of Glasgow, and colleagues. “Despite this, guidelines do not consistently recommend biomarker-based screening in diabetes and it is rarely performed in clinical practice. In part, this is because the clinical value of screening and early targeted intervention remains unknown.”
Taylor-Sweet et al. hoped to learn more about the potential of such screening interventions with TARTAN-HF, a multicenter randomized controlled trial that recruited more than 700 patients with type 1 or type 2 diabetes. The median age was 71 years old, 69% were men and 90% of patients had type 2 diabetes. None of the patients had known HF, but they did all present with at least one known HF risk factor.
From 2023 to 2025, patients were randomized to either receive NT-proBNP screening or usual care. If NT-proBNP screening results were ≥125 pg/mL, echocardiography was ordered to further evaluate the patient’s heart.
Overall, after six months, HF was diagnosed in 24.6% of patients in the screening group compared to 1% of the usual care group. These were most commonly diagnoses of heart failure with preserved ejection fraction (HFpEF). Patients with newly diagnosed HF tended to be older and have type 2 diabetes. These individuals also had lower quality-of-life scores as measured with the Kansas City Cardiomyopathy Questionnaire-12 overall summary score than patients without HF. The most common symptoms in patients with newly diagnosed HF were breathlessness (84%) and fatigue (53%).
“The high diagnostic yield of the targeted risk-based strategy in TARTAN-HF with the discovery of patients with a substantial burden of symptoms and limitation of global health status highlights the value of the proposed screening strategy to identify patients in whom HF disease–modifying therapies can be initiated,” the authors wrote. “This could potentially result in clinically meaningful changes in symptom burden and adverse outcomes in patients with established, yet previously unrecognized, HF. Although TARTAN-HF was not specifically statistically powered to address the effect of the screening process on clinical outcomes, we hope to provide further insights into the clinical impact of this strategy with extended follow-up of the cohort.”
The authors also noted that SGLT2 inhibitor use increased significantly in the screening group, jumping from 23.7% to 38.8% of patients. The use of loop diuretics in the screening group also went up, moving from 14.7% to 24.9% of patients. The usual care group did not see such sharp increases in the prescription of those medications.
“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,” the authors wrote.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.