People with diabetes develop heart failure more often and progress to symptoms faster. The American Diabetes Association now recommends natriuretic peptide testing to find asymptomatic cardiac dysfunction (stage B heart failure). This narrative review brings together experts from ten countries, India among them, on how that recommendation is being implemented.
The group identifies four things any programme must settle: the patient pathway from test to echocardiogram to treatment, the resources available, the training clinicians need, and cost-effectiveness. It discusses how different countries have chosen which patients to test and which thresholds should trigger action.
This is expert opinion and implementation experience, not new outcome data. Its practical value is in making the question concrete: before ordering the test, know what you will do with a raised result.
- Before ordering NT-proBNP in an asymptomatic patient with diabetes, agree locally what level triggers an echocardiogram.
- Interpret results with age, kidney function and obesity in mind; all alter NT-proBNP levels.
- Use a raised result as a reason to prioritise an SGLT2 inhibitor and tighter blood pressure control.
- Record the result so that a later rise can be recognised.
Why it matters
A screening test without an agreed next step produces anxiety and unused results rather than earlier treatment.
Don't overread it
This review reports expert experience; it does not show that screening improves outcomes.
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