Heart failure & cardiomyopathiesCohort study
Benefit of early initiation of disease-modifying therapy in community-based patients with suspected heart failure
- Cohort study with modelled treatment effect
- linked primary and secondary care data (Clinical Practice Research Datalink (CPRD))
- treatment effects from meta-analyses of placebo-controlled RCTs in established heart failure (HF)
Authors' conclusion
In community-based patients with suspected HF and elevated NT-proBNP, the early initiation of an SGLT2i and an MRA in patients with a pre-existing non-HF-related indication for treatment may reduce the risk of early adverse outcomes whilst awaiting diagnostic echocardiography.
Study context
- Population
- Community-based patients with suspected HF (NT-proBNP ≥ 400 pg/mL), no HF history, not on SGLT2i or mineralocorticoid receptor antagonist (MRA); 2015–2023
- Participants
- 74,945 patients
- Exposure
- Modelled early initiation of SGLT2 inhibitor and/or MRA vs no initiation at elevated NT-proBNP
- Outcome
- HF hospitalization as first recorded HF diagnostic event or all-cause death, in patients without documented HF diagnosis and no echocardiography
- Follow-up
- 12 months
Main finding
As reported in the abstract
HF hospitalization or death with SGLT2i + MRA started at elevated NT-proBNP in those with a pre-existing non-HF indication (modelled)
Events avoided per 1000 treated
84
NNT
12 (95% CI 11-14)
Observational data: associations, not effects.
Further findings
HF diagnosis recorded within 12 months
- HF diagnosis
- 24 082 (32%)
- As outpatient
- 15 398 (64%)
- During HF hospitalization
- 8684 (36%)
Original publication
Benefit of early initiation of disease-modifying therapy in community-based patients with suspected heart failure. Eur Heart J. Published 29 August 2025. doi:10.1093/eurheartj/ehaf675
Summarised from the published abstract; every number is checked against it