A study involving over 700 people in west central Scotland has found as many as one in four patients living with diabetes had undiagnosed heart failure. The findings of the landmark study presented to the American College of Cardiology (ACC) Conference in New Orleans today, further cement recognition of Glasgow as a leading global centre for heart failure research.

Heart failure, a long-term condition where the heart loses its ability to pump blood efficiently, is a common cardiovascular complication of diabetes. However, there has previously been only limited evidence to support widespread screening for undiagnosed heart failure in people living with diabetes.

Now a study published today suggests following a simple GP-led pathway could identify significant numbers of people living with undiagnosed heart failure and allow them to be treated.

The TARTAN HF study led by the University of Glasgow – in collaboration with AstraZeneca, Roche Diagnostics, Us2.ai, NHS Greater Glasgow & Clyde and NHS Lanarkshire – looked at people with type 1 or type 2 diabetes who also had one or more additional heart failure risk factors making them more likely to develop heart problems.

Over 700 people were randomly assigned either to receive heart failure screening or to continue with their usual care.

Those screened had a blood sample tested for their NT-proBNP levels – a marker for heart muscle strain – with those whose levels were elevated by 49% or more from normal then followed up with a fast-track echocardiography ultrasound to diagnose heart failure.

Hidden heart failure

The screening uncovered a large number of previously unrecognised cases of heart failure, with approximately one in four (24.9%) people found to have the condition within six months. In contrast, only 1% in the control group were found to have heart failure whilst continuing their usual care.

Dr Kieran Docherty, Clinical Senior Lecturer at the University of Glasgow’s School of Cardiovascular & Metabolic Health and a co-lead of the TARTAN-HF trial, says the study results support the case for a formal screening strategy for people with diabetes who have additional heart failure risk factors such as a history of a heart attack or kidney disease:

“We know that many of the symptoms and signs of heart failure are non-specific and may go unrecognised as potentially being due to heart failure for a long time.

“The strategy used in our trial is simple and easy-to-implement in clinical practice and will aid in the early identification of heart failure in people with diabetes and facilitate the initiation of medications that we know improve outcomes in patients with heart failure.”

Of the participants found to have heart failure, almost all had preserved ejection fraction, the heart not filling efficiently with blood, which can be difficult to detect without testing.

The study also examined the prescribing of a class of drug known to benefit heart failure patients, finding that use of these medicines by patients allocated to screening increased from 24% at the start of the study to 39% at six months.

There was a 55% reduction in the rate of hospitalisation for heart failure or death (3.1% versus 6.8%) over the duration of the trial for those who had been screened.

University of Glasgow Professor of Cardiology, Mark Petrie, who co-led the investigation, says the results of TARTAN-HF highlight that a substantial number of people living with diabetes are also living with unrecognised heart failure:

“These people have a significant burden of limiting symptoms and impaired quality of life.

“The screening process tested in TARTAN-HF is easy-to-implement in clinical practice and could significantly benefit people living with diabetes through the earlier identification of heart failure and implementation of evidence-based drugs which improve outcomes and reduce symptom burden.

“Further screening strategies could help identify other undiagnosed cardiovascular conditions, including atrial fibrillation and aortic stenosis.

“Going forward, larger trials in other regions and countries would be beneficial to more widely demonstrate the performance of heart failure screening in these patients.”

Dr Edward Piper, Medical Director, AstraZeneca UK, said:

“Delayed diagnosis and treatment of Heart Failure in people with type 2 diabetes contributes to poor long-term outcomes. TARTAN-HF demonstrates that targeted, risk-based screening can identify previously undiagnosed heart failure in approximately one in four high-risk patients with diabetes enabling earlier intervention with guideline-directed therapy.

“At AstraZeneca we're committed to working with academic partners to turn strong science into practical solutions that have the potential to transform patient care."

Dr Christian Simon, Head of Global Medical Affairs at Roche Diagnostics added:

“We are proud to have supported the landmark TARTAN-HF trial. These findings demonstrate the transformative power of early, accessible diagnostics like the NT-proBNP blood test.

“By identifying unrecognised heart failure in people with diabetes, we enable clinicians to initiate appropriate treatments sooner, ultimately improving patient outcomes and lives."

 

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