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. 2025 May;88(2):420-425.
doi: 10.1007/s12020-024-04157-9. Epub 2025 Jan 12.

Assessing the risk of heart failure in type 2 diabetes: a prediction algorithm to sustain the evaluation of NT-proBNP in primary care

Francesco Lapi  1 , Ettore Marconi  2 , Gerardo Medea  3 , Iacopo Cricelli  4 , Damiano Parretti  3 , Alessandro Rossi  3 , Claudio Cricelli  3
Affiliations

Assessing the risk of heart failure in type 2 diabetes: a prediction algorithm to sustain the evaluation of NT-proBNP in primary care

Francesco Lapi et al. Endocrine. 2025 May.

Abstract

Purpose: Heart failure (HF) is a disease that leads to approximately 300,000 fatalities annually in Europe and 250,000 deaths each year in the United States. Type 2 Diabetes Mellitus (T2DM) is a significant risk factor for HF, and testing for N-terminal (NT)-pro hormone BNP (NT-proBNP) can aid in early detection of HF in T2DM patients. We therefore developed and validated the HFriskT2DM-HScore, an algorithm to predict the risk of HF in T2DM patients, so guiding NT-proBNP investigation in a primary care setting.

Methods: Using a primary care database, we formed a cohort of patients aged ≥18 years diagnosed with T2DM between 2002 and 2022. A multivariate Cox model was adopted to assess the determinants associated with the occurrence of HF to combine them to form an individual score.

Results: Within a cohort of 167,618 patients (52.3% males; mean age 64.4 (SD: 14.4); HF rate equal to 6.7 cases per 1000 person-years), we developed the HFriskT2DM-HScore. When it was applied to the validation sub-cohort we found an explained variation and discrimination value of 43% (95% CI: 42-44) and 81% (95% CI: 0.80-0.83), respectively. Calibration slope was equal to 0.93 (95% CI: 0.81-1.1; p = 0.3123).

Conclusion: The HFriskT2DM-HScore might be implemented as a decision support system for primary care to appropriately ease the prescription of NT-proBNP and early identification of HF.

Keywords: Case finding; Heart failure; NT-proBNP; Type 2 diabetes.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: F.L., E.M., and I.C. provided consultancies in protocol preparation for epidemiological studies and data analyses for Roche Diagnostics, Astra Zeneca, Novartis, MSD. IC is an employee at Genomedics SRL. G.M., D.P., A.R. and C.C. provided clinical consultancies for Roche Diagnostics, Astra Zeneca, Novartis, MSD. Ethical approval: The study protocol was approved by the Scientific Committee of the Italian College of General Practitioners and Primary Care. This study followed the principles of the Declaration of Helsinki, and it is compliant with the ENCePP (European Network of Centres for Pharmacoepidemiology and Pharmacovigilance) Guide on Methodological Standards in Pharmacoepidemiology. Furthermore, as this is a retrospective, non‐interventional, non-pharmacological observational study. There is therefore no need for informed consent (Italian Drug Agency note dated 3rd of August 2007; GU n.31 7th February 2023). Consent to participate: Not applicable. Consent to publish: Not applicable.

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