Delays in diagnosis and treatment for patients with suspected heart failure (HF) in the community can lead to preventable hospitalisations and deaths. A new modelling study by Dr Kieran Docherty and colleagues suggests that early initiation of disease-modifying therapies in select patients at the time of an elevated natriuretic peptide test could significantly reduce these adverse outcomes.¹

Methodology

This retrospective cohort study analysed linked primary and secondary care data from the UK Clinical Practice Research Datalink (CPRD) between January 2015 and March 2023. The cohort included 74,945 patients with no prior HF diagnosis who had a community-measured N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of ≥400pg/mL.¹

The analysis modelled the effect of initiating a sodium-glucose cotransporter 2 inhibitor (SGLT2i), a mineralocorticoid receptor antagonist (MRA), or both at the time of the elevated NT-proBNP measurement. This intervention was applied to patients who already had a non-HF-related indication for these treatments, such as type 2 diabetes, chronic kidney disease (CKD), or resistant hypertension. The primary outcome was a composite of HF hospitalisation or all-cause death over 12 months.¹

Results

Within 12 months, 32% of patients in the cohort received a HF diagnosis, with 36% of these diagnoses occurring during a hospitalisation. The modelling estimated that if both an SGLT2i and an MRA were initiated at the time of the elevated NT-proBNP test in patients with a pre-existing indication, 84 primary outcome events would be prevented per 1000 patients treated at 12 months.¹

This corresponds to a number needed to treat (NNT) of 12 to prevent one event. The benefit was even more pronounced in the higher-risk group with an NT-proBNP >2000pg/mL, where the NNT was 7.¹

Interpretation

The findings suggest that initiating SGLT2i and MRA therapy in patients with suspected HF and a pre-existing indication for these drugs could be a valuable strategy to mitigate risk while awaiting definitive diagnostic echocardiography. This approach ensures patients receive appropriate, guideline-recommended treatment for their comorbidities, which may also prevent or treat their undiagnosed HF. The authors concluded, "These findings suggest a simple clinical strategy with potentially large public health benefits."¹

This study was funded by AstraZeneca.

References

1. Docherty KF, Heywood B, Bayes-Genis A, et al. Benefit of early initiation of disease-modifying therapy in community-based patients with suspected heart failure. Eur Heart J 2026;47(8):927–938. https://doi.org/10.1093/eurheartj/ehaf675

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