Dr. Michael Fulks, Consulting Medical Director, highlights a report discussing the prevalence and recommendation for annual screening of heart failure in those with diabetes.
Such is the conclusion of a recent consensus report from the American Diabetes Association which begins with the statement that diabetics have a prevalence of heart failure (HF) up to 22% and ends with the recommendation for annual screening. Reference to this report has appeared in various medical and popular media.
Digging a little deeper into the report and referenced literature reveals that the presence of diabetes roughly doubles the risk of HF for males and even more for women as compared to those without diabetes, but prevalence would reach 22% only for selected cohorts. HF may also be the most common presentation of heart disease in DM and results not just from macrovascular CAD but from a “diabetic cardiomyopathy” without obstructive CAD that may be the result of diabetic microvascular disease. These findings certainly suggest selective screening for pre-symptomatic or minimally symptomatic heart failure may have value but hardly supports the onerous and costly recommendation of annual screening especially considering that the impact of HF treatment may be more symptom relief than mortality reduction.
What is clear from this report is that DM is a strong additional risk factor for HF and that HF may be present even if not apparent or diagnosed. Many life insurers now test all applicants with NT once beginning at age 50 and the asymptomatic HF risk associated with DM makes this type of screening even more cost-effective. Based on medical literature and on work done internally at Clinical Reference Laboratory (CRL), it is not clear that NT and troponin are equivalent screening tools for HF and, for now, there is more support for screening with NT. Whether earlier or more frequent, screening for HF is warranted for those with diabetes remains uncertain. Albuminuria is already routinely screened for in diabetics both for life insurance and for health maintenance being a sensitive indicator of vascular damage including that from diabetic microvascular disease. It may identify many of those needing additional evaluation for HF.
About the Author
Michael Fulks, MD, Consulting Medical Director, is board-certified in internal and insurance medicine. After leaving practice, he served as a medical director, creating or editing several underwriting manuals and preferred programs. More recently, Mike has consulted for CRL participating in its mortality research on laboratory test results, BP and build, and in the development of risk-scoring tools for laboratory and non-laboratory data.