A significant proportion of people living with diabetes have undiagnosed heart failure, a major study has concluded, prompting calls for systematic screening within this high-risk group.
The TARTAN-HF trial, led by the University of Glasgow, found that approximately one in four (24.9%) of diabetes patients deemed at high risk were found to have previously undetected heart failure. The research underscores a silent and serious complication facing the UK’s estimated 4 million diagnosed diabetics, a figure projected to soon represent one in ten adults.
The Screening Strategy
The landmark trial investigated a two-step screening method designed for clinical practicality. High-risk diabetes patients first received a simple NT-proBNP blood test, a biomarker indicating cardiac strain already supported by NHS guidelines for suspected cases. Those with elevated levels then underwent an echocardiogram, a heart scan.
This targeted approach proved highly effective, with almost all heart failure cases detected being of the preserved ejection fraction (HFpEF) type, a form notoriously difficult to identify without dedicated testing due to its non-specific symptoms. Dr Kieran Docherty, a clinical senior lecturer at the University of Glasgow’s School of Cardiovascular & Metabolic Health and a key investigator on the trial, stated: “Our results from the landmark TARTAN-HF trial identified heart failure in a large proportion of people living with diabetes, emphasising the need for a heart failure screening strategy in this group of patients.”
The trial, which involved collaboration with NHS Greater Glasgow & Clyde, NHS Lanarkshire and several industry partners, demonstrated that early detection via this pathway led to increased use of proven guideline-directed medications. Over a median follow-up of 18 months, screened patients showed a meaningfully lower risk of death or hospitalisation for heart failure.
Broader Implications for Health Services
The findings highlight a critical intersection of two major health challenges. Individuals with diabetes are known to be two to four times more likely to develop heart failure than those without, often at a younger age. The conditions frequently co-exist, with approximately 29% of UK heart failure patients also having diabetes—a figure rising to 37% for those hospitalised. This overlap carries a poorer prognosis and significantly increased cardiovascular mortality.
Heart failure itself affects nearly one million people in the UK, accounting for around 200,000 new diagnoses and 2% of the total NHS budget annually. Diagnosis is often delayed, with many patients only identified after an emergency hospital admission, a situation exacerbated by the COVID-19 pandemic’s impact on care. Symptoms can be mistakenly attributed to other conditions, with women more likely to be misdiagnosed than men.
The research adds weight to the concept of “diabetic cardiomyopathy,” where diabetes itself acts as an independent risk factor for heart failure, even in the absence of other obvious cardiac issues.
A Call for Integrated Care
The trial’s recommendation is clear: implement a proactive, systematic screening strategy within diabetic care pathways. The proposed model of a primary care blood test followed by specialist referral for scanning mirrors existing NHS advice for suspected heart failure, but suggests applying it pre-emptively to a defined high-risk diabetic population.
Such a strategy could alter the management landscape. Medications like SGLT2 inhibitors, originally developed for diabetes, are now also used to reduce heart failure hospitalisation, illustrating the therapeutic overlap. Earlier diagnosis allows for earlier intervention with these and other guideline-directed therapies, alongside crucial lifestyle modifications.
With undiagnosed diabetes also common in patients hospitalised for acute heart failure and linked to increased mortality, the TARTAN-HF trial points to a necessary shift towards integrated screening and management of these interconnected conditions to improve outcomes and reduce the substantial burden on the NHS.
