Researchers at UT Southwestern Medical Center have made a significant breakthrough in preventing heart failure in patients with type 2 diabetes.
Their study, published in the journal Circulation, introduces a two-step screening protocol that efficiently identifies diabetic patients who require medication to prevent heart failure.
Heart failure is a common complication of diabetes, and identifying those at risk has been challenging. Traditionally, doctors have used one-step screening methods such as clinical risk scores, biomarker tests, or echocardiography.
However, these methods sometimes miss patients who, despite being classified as low-risk, still develop heart failure.
Moreover, comprehensive testing with biomarkers or echocardiography for all diabetic patients isn’t always practical or cost-effective.
The new approach proposed by Dr. Ambarish Pandey and his team involves combining clinical risk assessment with biomarker testing in a sequential manner.
This means first evaluating patients using a clinical risk score and then conducting a blood test for natriuretic peptide levels in those deemed low-risk.
Natriuretic peptides are proteins produced by the heart under stress, serving as a biomarker for cardiovascular disease.
This innovative strategy emerged from analyzing data from 6,293 diabetic patients across seven cohort studies. The researchers compared various screening methods and their effectiveness in predicting heart failure over five years.
They discovered that about 30% to 50% of heart failure cases in patients without prevalent atherosclerotic cardiovascular disease (ASCVD) occurred in those categorized as low-risk by a single screening method.
However, adding a second screening step correctly identified approximately 85% of actual heart failure cases.
The most efficient two-step strategy involved first assessing the WATCH-DM risk score for all patients, followed by natriuretic peptide testing only for those deemed low-risk based on this score.
While echocardiography is a useful tool for further risk assessment, it’s more costly and time-consuming than a simple blood test, making it less practical for routine use.
Dr. Kershaw Patel, the study’s first author, emphasized the efficiency of this approach in targeting preventive therapies.
It’s a significant advance in the field, providing doctors with a more accurate assessment of patients’ risk and potentially guiding more aggressive preventive treatments.
The study builds on previous work at UT Southwestern in developing novel risk scores and biomarker-based assessments for heart failure risk prediction.
The goal is to improve preventive treatment by using cost-effective, easily implemented screening tools in clinical settings.
The research team hopes that further investigation of this two-step strategy will confirm its clinical success and cost-effectiveness, leading to a standardized approach for diabetic patients at risk of heart failure.
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The research findings can be found in Circulation.
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