Optimal Screening for Predicting and Preventing the Risk of Heart Failure Among Adults With Diabetes Without Atherosclerotic Cardiovascular Disease: A Pooled Cohort Analysis
Authors' conclusion
Selective NT-proBNP testing based on the WATCH-DM score efficiently identified a high-risk primary prevention population with diabetes expected to derive marked absolute benefits from SGLT2i to prevent HF.
Study context
- Population
- Adults with diabetes, no heart failure (HF) and no atherosclerotic cardiovascular disease (ASCVD) at baseline77.7% without ASCVD
- Participants
- 6,293 adults
- Exposure
- 1-step vs 2-step HF screening strategies
- Outcome
- Proportion of HF events identified, NNT and number needed to screen to prevent 1 HF event with an SGLT2i, and cost of screening
- Follow-up
- 5 years
Methodological details7 community-based cohorts
- 7 community-based cohorts
Main finding
As reported in the abstract
HF events captured, NNT, number needed to screen and cost by screening strategy
| Group | Cost |
|---|---|
| WATCH-DM/NT-proBNP | $1061 |
| NT-proBNP/hs-cTn | $2894 |
| NT-proBNP/echo-DbCM | $16 358 |
Cost
WATCH-DM/NT-proBNP$1061
NT-proBNP/hs-cTn$2894
NT-proBNP/echo-DbCM$16 358
- 1-step strategies: NNT in high-risk participants (22 for NT-proBNP to 37 for echo-DbCM)
- 22–37
- 1-step strategies: HF events among low-risk participants (29% for echo-DbCM to 47% for hs-cTn)
- 29%–47%
- 2-step strategies: HF events captured in high-risk subgroup
- 75-89%
- 2-step strategies: NNT
- 30-32
- 2-step strategies: number needed to screen, similar
- 45-61
Observational data: associations, not effects.
Further findings
Incident HF and NNT with SGLT2i, participants without ASCVD · 5 years
- Incident HF
- 6.2%
- NNT to prevent 1 HF event with SGLT2i
- 43 (95% CI, 29-72)
Original publication
Optimal Screening for Predicting and Preventing the Risk of Heart Failure Among Adults With Diabetes Without Atherosclerotic Cardiovascular Disease: A Pooled Cohort Analysis. Circulation. Published 11 November 2023. doi:10.
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