Translating Guidelines into Practice: Implementation of NT-proBNP Testing for Early Heart Failure Detection in Diabetes, a Narrative Review

Diabetes and heart failure are strongly correlated, and people with diabetes are more likely to rapidly transition to overt heart failure and develop symptoms. Early identification and management of heart failure can improve outcomes. Elevated concentrations of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) cardiac biomarker are associated with increased risk of cardiovascular events and mortality in people with diabetes, and measurement of this biomarker is now recommended for early detection of Stage B heart failure (asymptomatic cardiac dysfunction), according to American Diabetes Association (ADA) guidelines. While several countries have published local consensus statements on how to address heart failure risk in diabetes, this assessment has not yet been universally adopted in practice. A multidisciplinary group of experts from ten countries (Ireland, Italy, Lithuania, Portugal, Slovenia, Spain, Switzerland, Turkey, India, and the USA) convened to discuss their experience of implementing ADA guidelines in clinical practice. This review reports their experiences in context with existing literature on the subject, providing updated guidance on how local caregivers and multidisciplinary teams can effectively implement and manage NT-proBNP-based early detection of heart failure risk in people with diabetes at a national level. Country-specific implementation efforts must consider multiple parameters for any early detection program, including: 1) The patient pathway; 2) The availability of resources; 3) The educational needs of clinicians; and 4) Cost-effectiveness. A multipronged approach with a clear pathway for evaluation, diagnosis, and treatment is therefore required to facilitate the implementation of NT-proBNP programs for early heart failure detection on a global level. This review discusses the approaches proposed in different countries, fine-tuning the population in scope and the thresholds for biomarker interpretation and subsequent action, to achieve sustainable programs for early heart failure identification and management.