What method can identify patients with type 2 diabetes who are most at risk of hospitalization for heart failure?

Berg et al developed a biomarker-based score to determine risk of hospitalization for heart failure in individuals with type 2 diabetes (T2D). They were also able to identify individuals that would most benefit from treatment intervention with dapagliflozin, a sodium-glucose co-transporter 2 inhibitor.

Previously utilized risk scores, such as the Thrombolysis in Myocardial Infarction (TMI) Risk Score for Heart Failure in Diabetes (TRS-HFDM), compare five measures commonly assessed in routine care, including prior heart failure (HF). The team aimed to validate a score system that could identify patients for individualized interventions, with or without prior history of HF.

The investigators measured the biomarker high-sensitivity troponin T (hsTnT), and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) in 6,100 placebo-treated individuals from the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53 cohort (SAVOR-TIMI 53). The score was validated externally using more than 7,200 placebo-treated individuals participating in the Dapagliflozin Effect on CardiovascuLAR Events–Thrombolysis in Myocardial Infarction 58 (DECLARE-TIMI 58) study. The effect of dapagliflozin on hospitalization from heart failure was assessed by risk category in DECLARE-TIMI 58.

Findings demonstrated that the best indicators of risk of hospitalization were abnormal levels of NT-proBNP and hsTnT, and prior HF. Using these variables, the researchers were able to develop a risk gradient for hospitalization. For patients in the groups denoted intermediate, high, and very high risk, treatment with dapagliflozin greatly reduced the hospitalization rate. The drug had no clinically significant impact on the risk of being hospitalized in the low-risk group.

A separate secondary analysis of the DECLARE-TIMI 58 Trial concluded thatNT-proBNP and hsTnT levels were associated with the risk for future cardiovascular events in individuals with T2D and were helpful to identify patients at very high risk for atherosclerotic events that may derive reduction in risk of major adverse cardiovascular events with dapagliflozin.

Additional reporting by Rosemary Hope.

Disclosures: The SAVOR-TIMI 53 and DECLARE-TIMI 58 trials were supported by institutional research grants to Brigham and Women’s Hospital from AstraZeneca. Members of the research team declared relationships with AstraZeneca among other conflicts.