Active screening of patients with diabetes or COPD doubled new diagnoses of heart disease
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Key takeaways:
- Diagnostic screening strategy implemented in primary care identified new CVD.
- The most common new CVD diagnosis was heart failure.
In a new study, a diagnostic strategy utilizing tools readily available in primary care successfully identified new diagnoses of atrial fibrillation, CAD and HF among patients with type 2 diabetes or chronic obstructive pulmonary disease.
“Type 2 diabetes and chronic obstructive pulmonary disease (COPD) are strong risk factors for developing CVD. In fact, 20% to 41% of these patients have an unknown but treatable CVD. Heart failure is present in around 20% to 28%, for example, and coronary artery disease in up to 41%,” Amy Groenewegen, MD, general practitioner in training/PhD student at the University Medical Center Utrecht, the Netherlands, said during a press conference at the European Society of Cardiology Congress. “We aimed to uncover CVD at an early stage with an easy-to-use diagnostic strategy in primary care patients with COPD and/or type 2 diabetes.”
Image: Adobe Stock
The RED-CVD researchers developed an early diagnosis strategy aimed at detecting AF, HF and CAD. The strategy consists of three steps:
- a patient questionnaire about symptoms of AF, HF and CAD;
- if patients scored above a certain threshold on the questionnaire, they underwent further screening, including physical examination, ECG and N-terminal pro-B-type natriuretic peptide measurement; and
- if any of the aforementioned tests were abnormal, referral to a cardiologist was made by the general practitioner at their discretion.
The early diagnosis strategy was tested in a cluster-randomized trial in general practices across the Netherlands. Patients at practices in the intervention group underwent the early diagnosis strategy, which was performed by general practitioners and nurses during routine visits as part of their disease management, whereas patients from control practices received usual care. There were about 650 patients in each group, of whom 87% had type 2 diabetes and 20% had COPD. The average age was 68 years and 40% were women.
After 1 year, new CVD diagnoses were made in 8% of the intervention group and 3% of the usual care group. The primary diagnosis was HF, with new diagnoses in 4.5% of the intervention group and 1.5% of the usual care group. Of all types of HF, HF with preserved ejection fraction was the most common diagnosis, in 3.2% of the intervention group and 0.7% of the usual care group, according to the results.
The intervention also identified more patients with AF (2.1% vs. 0.8%) and CAD (2.6% vs. 1.4%), according to Groenewegen.
“Our strategy more than doubled new diagnoses of heart failure, atrial fibrillation and CAD in patients with type 2 diabetes or COPD in primary care,” Groenewegen said during the press conference.
The OR for new diagnoses was 2.62 (95% CI, 1.5-4.55), according to the results.
Groenewegen said if they were to apply this screening strategy to the more than 920,000 patients with COPD and/or type 2 diabetes in the Netherlands, it would identify an estimated 48,000 additional CVD diagnoses.
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Groenewegen A, et al. Hot Line 8. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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