Revolutionary Two-Step Screening Uncovered by UT Southwestern for Preventing Heart Failure in Diabetic Patients

A newly proposed two-step screening process stands to significantly enhance our ability to predict heart failure in patients with diabetes. Researchers at UT Southwestern Medical Center led the study, which unpacks how this approach is even effective in patients who were initially considered a low-risk following only a clinical risk assessment.

Limitations of Current Assessment Strategies

Cardiovascular disease is often a serious health complication of diabetes, with heart failure one of its more common occurrences. Many a time, doctors use one-step screening methods such as clinical risk scores, biomarker tests, or echocardiography, to identify patients at a higher risk for developing heart failure. These tools, however, sometimes leave low-risk patients largely overlooked, a group that can still end up developing heart failure. Also, the mass testing of all diabetic individuals using expensive biomarker tests or echo assessments is usually neither cost-efficient nor practical.

The Two-Step Approach

Dr. Ambarish Pandey, Associate Professor of Internal Medicine in the Division of Cardiology at UT Southwestern, suggests that sequentially combining these risk assessment strategies offers a better chance of efficient and economical screening for heart failure. A second step, such as administering a blood test for natriuretic peptide levels in low-risk patients based on the clinical risk score, can better fine-tune the risk predictions.

Natriuretic peptides are proteins the heart produces when undergoing stressful stretching of the muscle. By conducting these tests, doctors could predict and counteract heart disease more accurately and use preventive therapies, like sodium-glucose cotransporter 2 inhibitors (SGLT2i), to protect their patients' heart health.

Testing the Two-Step Protocol

The research included data from 6,293 patients who had diabetes and that participated in seven cohort studies. The studies include 4,889 patients with no signs of atherosclerotic cardiovascular disease (ASCVD). Each patient underwent screening to ascertain their level of risk for heart failure.

Researchers could then compare the screening methods and their subsequent heart failure risk after five years, to identify the protocol that best predicted those at risk.

Findings

They found that when a second step was implemented, nearly 85% of actual heart failure cases were spotted. This figure is compared to the 30% to 50% of heart failure events that were evident in the population without prevalent ASCVD, and that was marked low-risk with a single screening strategy.

These findings suggest that the two-step strategy may help many patients who could benefit from more aggressive preventive treatment but whose risk is often overlooked.

Next Steps in Research

• Further research is necessary to assess the clinical success and cost-effectiveness of this new protocol.
• Other possibilities include incorporating different two-step strategies including WATCH-DM, blood tests for natriuretic peptides, and echocardiography.

Conclusion

This study presents a significant stride in our quest to improve preventive interventions for heart failure in diabetics. The two-step protocol, as recommended by Dr. Pandey and colleagues, makes screening more accurate and can potentially spare significant suffering of those diabetic patients most at risk of developing heart failure.