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Targeted Assessment in High-Risk Patients With Diabetes to Identify Undiagnosed Heart Failure (TARTAN-HF)
Daniel Taylor-Sweet1, Mark C Petrie1, Gemma McKinley2
1BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom.
Insights
A natriuretic peptide-based screening strategy significantly increased the identification of undiagnosed heart failure (HF) in people with diabetes. This approach is crucial for early intervention in high-risk diabetic populations.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- Heart failure (HF) is a frequent cardiovascular complication in patients with diabetes.
- Early detection of unrecognized HF allows for timely initiation of disease-modifying therapies.
- Current international guidelines for diabetes and HF management offer inconsistent recommendations for HF screening in diabetic individuals.
Purpose of the Study:
- To assess the diagnostic yield of a screening strategy utilizing natriuretic peptides for identifying HF in individuals with diabetes and associated risk factors.
- To compare the effectiveness of natriuretic peptide-based screening against usual care in detecting undiagnosed HF.
Main Methods:
- The study was a prospective, multicenter, randomized controlled trial named TARTAN-HF.
- Participants aged ≥40 with type 1 or type 2 diabetes and at least one HF risk factor, without known HF, were randomized to either natriuretic peptide screening or usual care.
- Screening involved measuring N-terminal pro-B-type natriuretic peptide (NT-proBNP) with echocardiography if NT-proBNP levels were ≥125 pg/mL. The primary outcome was HF diagnosis at 6 months.
Main Results:
- The screening group showed a significantly higher rate of HF diagnosis (24.6%) compared to the usual care group (1%) at 6 months (OR: 58; P < 0.001).
- The number needed to screen was 5, indicating high efficiency. Heart failure with preserved ejection fraction (HFpEF) was the most common phenotype (23%).
- Sodium-glucose cotransporter 2 inhibitor use increased in the screening group, and patients diagnosed with HF had significantly poorer health status.
Conclusions:
- A natriuretic peptide-based screening strategy effectively identifies a substantial number of diabetic patients with previously unrecognized symptomatic HF, predominantly HFpEF.
- Further investigation and consideration of HF screening strategies are recommended for the management of individuals with diabetes.
- The study highlights the importance of proactive HF screening in the diabetic population to improve patient outcomes.
Background:
Heart failure (HF) is a common cardiovascular complication of diabetes. Early identification of unrecognized HF enables initiation of disease-modifying therapies. International diabetes and HF clinical practice guidelines are inconsistent with respect to recommendations for screening for HF in people with diabetes.
Objectives:
The purpose of this trial was to evaluate the diagnostic yield of a natriuretic peptide-based HF screening strategy in people with diabetes and HF risk factors.
Methods:
TARTAN-HF (Targeted Assessment in high-Risk paTients with diAbetes to ideNtify undiagnosed HF) was a prospective, multicenter, unblinded, randomized controlled trial. Community-based participants aged ≥40 years with type 1 or type 2 diabetes and at least 1 additional HF risk factor, but without known HF, were recruited in the west of Scotland. Participants were randomized to N-terminal pro-B-type natriuretic peptide screening (with echocardiography if N-terminal pro-B-type natriuretic peptide ≥125 pg/mL) or usual care. The primary outcome was a HF diagnosis at 6 months. HF was defined according to 2021 European Society of Cardiology Heart Failure guidelines. Secondary and exploratory outcomes included HF phenotype, sodium-glucose cotransporter 2 inhibitor use, and a composite of HF hospitalization or death.
Results:
From January 11, 2023 to May 29, 2025, 706 participants were randomized (354 screening; 352 usual care). Median age was 71 years, 69% were male, and 90% had type 2 diabetes. Median duration of diabetes was 12.5 years. Two HF risk factors were present in 26% and 3 or more risk factors in 10%. At 6 months, HF was diagnosed in 87 (24.6%) in the screening group vs 2 (1%) in usual care (OR: 58; 95% CI: 14-236; P < 0.001). Most cases were HF with preserved ejection fraction (23%). The number needed to screen was 5 (95% CI: 4-6). Sodium-glucose cotransporter 2 inhibitor use increased from 24% to 39% in the screening group. Patients found to have unrecognized HF had significantly impaired health status as assessed using the Kansas City Cardiomyopathy Questionnaire-12 overall summary score compared with those without HF (median: 65.6 vs 89.6).
Conclusions:
A HF screening strategy identified a large proportion of patients living with diabetes with unrecognized symptomatic HF (mostly HF with preserved ejection fraction). Screening strategies for HF should be further investigated and considered for adoption in the care of people with diabetes. (Targeted Assessment in high-Risk paTients with diAbetes to ideNtify undiagnosed Heart Failure: NCT05705869).
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