One in four diabetics has undiagnosed heart failure; study

A major UK-led study has found that undiagnosed heart failure (HF) can be detected in people with high-risk diabetes using a simple, community-based care pathway.

The TARTAN-HF trial, run by the University of Glasgow with funding from AstraZeneca, Roche Diagnostics, and echocardiography software firm Us2.ai, found that around one in four (24.9%) patients with diabetes and one or more risk factors for HF had a diagnosis of HF within six months, despite being in contact with healthcare services, compared to 1% of a control group.

The GP-led pathway proposed by the researchers is an initial GP consultation to gauge symptoms, an NT-proBNP biomarker blood test to screen for potential HF, and a fast-track to a cardiac ultrasound test.

The new approach was compared to the current, routine clinical care for diabetes in the NHS in 700 subjects recruited at two NHS hospitals in Glasgow.

According to the investigators, who are presenting the study at the American College of Cardiology (ACC) congress today, the pathway enabled earlier identification of HF and an earlier start for guideline-directed therapy that could slow down disease progression, extend life, alleviate symptoms, and improve patients' quality of life.

The pathway has been designed to work with established NHS procedures, targeting the health service's diagnostic resources to where they are most needed, and "offering a scalable approach for primary care teams and specialists" in cardiology, nephrology and diabetology.

"The results of TARTAN-HF highlight that a substantial number of people living with diabetes are living with unrecognised heart failure," said TARTAN-HF investigator Mark Petrie, professor of cardiology at the University of Glasgow.

"These people have a significant burden of limiting symptoms and impaired quality of life," he added. "The screening process tested in TARTAN-HF is easy to implement in clinical practice and could significantly benefit people living with diabetes."

The researchers are now working on additional analyses to work out how the earlier detection of undiagnosed HF could affect the costs of providing NHS care for at-risk diabetes patients.

"Delayed diagnosis and treatment of heart failure in people with type 2 diabetes contributes to poor long-term outcomes," said Dr Edward Piper, medical director at AstraZeneca UK, whose SGLT2 inhibitor Forxiga (dapagliflozin) is a key therapy for some patients with HF.

The company said in a statement that the findings support the objectives of the NHS England 10-Year Plan and NHS Scotland's Heart Disease Action Plan to identify and treat cardiovascular disease early and in the community.

Photo by Marek Studzinski on Unsplash