- Design
- Prospective, multicentre, unblinded randomised trial
- Population
- 706 community adults ≥40 with diabetes and ≥1 heart failure risk factor
- Primary outcome
- Heart failure diagnosis at 6 months
- Effect
- 24.6% vs 1%; OR 58 (95% CI 14–236); number needed to screen 5
TARTAN-HF, published in August, randomised 706 community patients in the west of Scotland aged 40 or over with diabetes and at least one additional heart failure risk factor. Screening used NT-proBNP, with echocardiography if it was 125 pg/mL or more; the comparison was usual care.
At six months, heart failure was diagnosed in 24.6% of the screened group against 1% with usual care. The number needed to screen was 5, and most cases were HFpEF. SGLT2 inhibitor use in the screened group rose from 24% to 39%. Those found to have heart failure already had markedly worse health status.
The trial measured diagnosis, not outcomes. But in a diabetes clinic, many of these patients would qualify for an SGLT2 inhibitor anyway — the diagnosis mostly sharpens the reason and the follow-up.
- Consider NT-proBNP in patients with diabetes who have another heart failure risk factor.
- Arrange echocardiography when NT-proBNP is 125 pg/mL or above.
- Ask directly about breathlessness and reduced exercise tolerance, which patients often attribute to age.
- Use a new HFpEF diagnosis as a firm reason to prescribe an SGLT2 inhibitor.
Why it matters
Much of the heart failure in diabetes clinics is present but unnamed, and so untreated.
Don't overread it
The trial shows more diagnoses, not yet fewer admissions or deaths.
The statistics, in plain English
A number needed to screen of 5 means testing five patients finds one new case. The odds ratio of 58 looks enormous because usual care found almost none; the absolute numbers are the clearer guide.
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