NT-proBNP Sampling May Improve Heart Failure Screening in Patients With Diabetes

A new, NT-proBNP-based heart failure (HF) screening strategy has identified a substantial proportion of patients living with diabetes with unrecognized symptomatic HF, highlighting the need for further adoption of similar screening techniques.¹

HF is a frequent complication in patients with diabetes. Risk is elevated even after controlling risk factors like hypertension, hypercholesterolemia, hyperglycemia, and albuminuria. Additionally, the increasing incidence of type 2 diabetes (T2D) is expected to increase the incidence of HF. However, guidelines for HF treatment do not consistently include biomarker-based screening, and it is rarely performed in clinical practice.^1,2

“To address this knowledge gap, we conducted a randomized controlled trial evaluating the diagnostic yield of a systematic natriuretic peptide-guided screening strategy to detect unrecognized symptomatic HF in adults with diabetes and additional risk factors for HF,” Daniel Taylor-Sweet, PhD, clinical fellow at NHS Golden Jubilee and research fellow at the University of Glasgow, and colleagues wrote.¹

The TARTAN-HF Trial

TARTAN-HF was a prospective, multicenter, unblinded, randomized controlled trial, one of several in the broader SYMPHONY program. This program aimed to examine the potential benefits of HF screening in a variety of populations. TARTAN-HF enrolled patients ≥40 years of age with an established diagnosis of type 1 diabetes (T1D) or T2D and ≥1 additional risk factor for HF. These risk factors included coronary artery disease, previous ischemic or embolic stroke, peripheral artery disease, or chronic obstructive pulmonary disease, among other factors.¹

Prior to randomization, medical and drug history were recorded, and patients were invited to complete the Kansas City Cardiomyopathy Questionnaire (KCC-12) and the EuroQol 5-Dimension 3-Level questionnaire. Eligible patients were then randomly assigned in a 1:1 ratio to either screening or usual care for HF, after which they were invited to an in-person study visit during which investigators measured NT-proBNP, sampled peripheral venous blood for hematology and biochemistry, sampled urine for urinary albumin-to-creatinine ratio, and a 12-lead electrocardiograph.¹

The trial’s primary endpoint was a diagnosis of HF at 6 months after randomization. This was defined as the presence of each of the following 3 criteria: signs and/or symptoms of HF, an elevated NT-proBNP concentration ≥125 pg/mL, and ≥1 echocardiographic structural or functional abnormality consistent with adverse cardiac remodeling or elevated filling pressures. These diagnoses were classified according to ejection fraction phenotype.¹

A total of 706 patients were randomized between January 2023 and May 2025, with 354 assigned to screening and 352 to usual care. Median age was 71 years, and 90% of patients had T2D. Median duration of diabetes was 12.5 years. 72% of patients had their diabetes managed in primary care, while the remainder were attending a secondary care diabetes clinic. The most common risk factors were chronic kidney disease (57%) and coronary artery disease (39%).¹

Screening With NT-proBNP

Among the patients assigned to screening, an HF diagnosis was ultimately made in 87 (24.6%). A diagnosis of HF with reduced ejection fraction (HFrEF) was made in 3 patients, HF with mildly reduced ejection fraction (HFmrEF) was made in 3 patients, and HF with preserved ejection fraction (HFpEF) in 81 patients (23%). No further diagnoses were made in the 6 months following randomization outside of the screening process. However, the usual care group only saw 2 diagnoses (odds ratio [OR], 58; 95% CI, 14-236; P <.001).¹

Ultimately, Taylor-Sweet and colleagues concluded that NT-proBNP-based screening is an effective method for improving HF diagnosis among patients who would otherwise have gone unrecognized. The team encourages further adoption of this and similar screening strategies to combat HF.¹

“The high diagnostic yield of the proposed screening strategy strengthens the case for the consideration of the implementation of natriuretic peptide-based screening for undiagnosed symptomatic HF in high-risk people with diabetes,” Taylor-Sweet and colleagues wrote.¹

References

1. Taylor-Sweet, D, Petrie, M, McKinley, G. et al. Targeted Assessment in High-Risk Patients With Diabetes to Identify Undiagnosed Heart Failure (TARTAN-HF). JACC. null2026, 0 (0). https://doi.org/10.1016/j.jacc.2026.06.042

2. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599-3726. https://academic.oup.com/eurheartj/article/42/36/3599/6358045