Introduction and Objective: Heart failure (HF) is a frequently unrecognized complication in people living with diabetes. Clinical practice guidelines recommend screening for HF using natriuretic peptide testing. We examined the performance of the AHA PREVENT risk model to detect unrecognized HF in a randomized trial of NT-proBNP-based screening in patients with diabetes and risk factors for HF.Methods: TARTAN-HF (NCT05705869) randomized community-based participants (n=706) with an established diagnosis of diabetes and risk factors for HF to a screening strategy of NT-proBNP testing followed by echocardiography if NT-proBNP was elevated (≥125pg/mL) or to usual care. Patients with known HF were excluded. All HF diagnoses were made in accordance with the 2021 ESC HF guidelines. In this exploratory analysis, we calculated the AHA PREVENT 10-year risk of HF in participants randomized to screening with complete data for risk model variables.Results: The AHA PREVENT 10-year HF risk was calculated in 335 of the 354 (95%) randomized to screening. Median predicted risk was 20.8% (IQR 13.5-29.2). Among participants with NT-proBNP ≥125 pg/mL (n=168), median predicted risk was higher than in those with NT-proBNP <125 pg/mL (23.2% [17.3-33.2] vs 17.1% [11.1-23.1]). Of the 168 (48%) with an elevated NT-proBNP, 84 (50%) were diagnosed with HF following echocardiography; predicted risk was higher in those with HF than in those without HF (median 26.5% vs. 21.1%). Restricting echocardiography to participants with NT-proBNP ≥125 pg/mL who were classified as high risk by the AHA PREVENT score (≥20%) would have reduced echocardiography use by 30% but would have missed 12 of 84 HF cases (sensitivity 86%).Conclusion: In patients with diabetes undergoing NT-proBNP-based screening, the AHA PREVENT risk model identified individuals at higher risk of HF and may improve screening efficiency by reducing the number of echocardiograms required.
D.R. Taylor-Sweet: None. M. Petrie: Consultant; Current; AstraZeneca. G. McKinley: None. L.M. McGlynn: None. R.T. Campbell: Research Support; Current; Roche Diagnostics, SQ Innovations. A. McConnachie: None. J.J. Mcmurray: Speaker’s Bureau; Current; Imagica Health, Intas Pharmaceuticals Ltd., J.B. Chemicals & Pharma. Ltd., Lupin Pharmaceuticals, Inc., ProAdwise Communications, Sun Pharmaceutical Industries Ltd., Translational Medicine Academy. Other – Director; Current; Global Clinical Trial Partners Ltd. Other – payments through Glasgow University from work on clinical trials, consulting and grants; Current; Alnylam Pharmaceuticals, Inc., Amgen Inc., AstraZeneca, Bayer AG, Cardurion Pharmaceuticals, Cytokinetics Inc., Novartis AG, British Heart Foundation, National Institutes of Health, SQ Innovations. Consultant; Current; AstraZeneca, AnaCardio Pharma, Bayer AG, Cardurion Pharma., Novartis AG, Alkem Metabolics. Speaker’s Bureau; Current; Canadian Me3dical and Surgical Knowledge, AstraZeneca, Emcure Pharma., Eris Lifesciences Ltd., European Academy of CME, Hikma Pharma. C.S. Lam: Research Support; Current; Novo Nordisk A/S, Roche Diagnostics. Consultant; Current; Alnylam Pharmaceuticals, Inc., Applied Therapeutics, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Boston Scientific Corporation, Bristol-Myers Squibb Company, CPC Clinical Research, Cytokinetics Inc., Eli Lilly and Company, Impulse Dynamics, Janssen Research & Development, LLC, Medscape, Merck & Co., Inc., Novartis AG, Pfizer Inc., Radcliffe Group, Roche Pharmaceuticals. Other – Consultant, Co-founder and Non-Executive Director; Current; Us2.ai. Consultant; Current; Anacardio AB, Corteria, Intellia Therapeutics. K. Docherty: Consultant; Current; AstraZeneca. Advisory Panel; Current; Eli Lilly and Company. Advisory Panel; Ended; Us2.ai, Bayer AG. Speaker’s Bureau; Ended; Roche Diagnostics. Advisory Panel; Ended; Abbott. Research Support; Current; Roche Diagnostics. Research Support; Ended; Boehringer Ingelheim International GmbH.
AzetraZenica, Roche Diagnostics, Us2.ai
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