Screening For Occult Heart Failure in Type 2 Diabetes Mellitus Using NT-proBNP: Real-World Evidence From a Tertiary Care Center in India

Objective Heart failure (HF) is an important underrecognized complication of type 2 diabetes mellitus (T2DM). Recent literature and recommendations support screening for HF among T2DM people attending the outpatient department (OPD) in non-emergency settings using a biomarker. The present study is a retrospective cross-sectional study that assesses the prevalence of screen positivity (S+) for undiagnosed HF among T2DM people (with normal electrocardiogram (ECG) and no history of heart disease) attending the OPD at a tertiary care center in India using N-terminal pro-B-type natriuretic peptide (NT-proBNP). It also highlights the risk factors for S+ for HF. Methods This is a retrospective cross-sectional study of the practice of NT-proBNP screening in T2DM to diagnose stage B HF. A total of 1,049 consecutive people with T2DM (age range: 18-75 years) attending the OPD of a tertiary care institute in India were screened for HF using NT-proBNP (cut off S+ >125 pg/mL). Demographic variables, vitals, smoking status, family history, status of hypertension, medications for diabetes, and glycemic control were recorded and correlated with the risk of S+ for HF. Results Of the 1,049 people with T2DM, 336 (32.03%) had S+ for HF. Those with S+ had higher age (62.5+9.3 vs 54.2 +10.6 years), longer duration of T2DM (14.4 +7.8 vs 9.6 +6.1 years), positive history for smoking (94 [28%] vs 55 [7.7%]) and tobacco chewing (66 [19.6%] vs 24 [3.4%]), higher blood pressures (both systolic [152.1+19.9 vs 134.6 +15 mmHg] and diastolic [87.7+9.6 vs 83.9+7.8 mmHg]), higher glycated hemoglobin (HbA1c) (8.4+1.4 vs 7.6+1 years), higher BMI (28.3+2.8 vs 27.2+2.1 kg/m2), presence of chronic kidney disease (CKD) (210 [62.5 %] vs 118 [16.5%]), and a positive family history of cardiac ailments (185 [55.1%] vs 122 [17.1%]) (p<0.05 for all). The above factors also correlated with increased chances of S+ for HF on regression analysis. Conclusion S+ for HF is common in people with T2DM attending OPDs. The S+ was associated with increasing age, longer duration of T2DM, smoking and tobacco chewing, uncontrolled hypertension and T2DM, obesity, the presence of CKD, use of pioglitazone and insulin, and positive family history. It is the need of the hour to widely extend routine screening for HF in T2DM patients using NT-proBNP in the OPD setting so that benefits of guideline-based therapy can be extended.