{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:20:26Z","timestamp":1791656426973,"version":"4.3.4"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","funder":[{"name":"NIH NHLBI","award":["R21HL169708"],"award-info":[{"award-number":["R21HL169708"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,1,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The optimal approach to identify individuals with diabetes who are at a high risk for developing heart failure (HF) to inform implementation of preventive therapies is unknown, especially in those without atherosclerotic cardiovascular disease (ASCVD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Adults with diabetes and no HF at baseline from 7 community-based cohorts were included. Participants without ASCVD who were at high risk for developing HF were identified using 1-step screening strategies: risk score (WATCH-DM [Weight, Age, Hypertension, Creatinine, HDL-C, Diabetes Control, QRS Duration, MI, and CABG] \u226512), NT-proBNP (N-terminal pro-B-type natriuretic peptide \u2265125 pg\/mL), hs-cTn (high-sensitivity cardiac troponin T \u226514 ng\/L; hs-cTnI \u226531 ng\/L), and echocardiography-based diabetic cardiomyopathy (echo-DbCM; left atrial enlargement, left ventricular hypertrophy, or diastolic dysfunction). High-risk participants were also identified using 2-step screening strategies with a second test to identify residual risk among those deemed low risk by the first test: WATCH-DM\/NT-proBNP, NT-proBNP\/hs-cTn, NT-proBNP\/echo-DbCM. Across screening strategies, the proportion of HF events identified, 5-year number needed to treat and number needed to screen to prevent 1 HF event with an SGLT2i (sodium-glucose cotransporter 2 inhibitor) among high-risk participants, and cost of screening were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>The initial study cohort included 6293 participants (48.2% women), of whom 77.7% without prevalent ASCVD were evaluated with different HF screening strategies. At 5-year follow-up, 6.2% of participants without ASCVD developed incident HF. The 5-year number needed to treat to prevent 1 HF event with an SGLT2i among participants without ASCVD was 43 (95% CI, 29\u201372). In the cohort without ASCVD, high-risk participants identified using 1-step screening strategies had a low 5-year number needed to treat (22 for NT-proBNP to 37 for echo-DbCM). However, a substantial proportion of HF events occurred among participants identified as low risk using 1-step screening approaches (29% for echo-DbCM to 47% for hs-cTn). Two-step screening strategies captured most HF events (75\u201389%) in the high-risk subgroup with a comparable 5-year number needed to treat as the 1-step screening approaches (30\u201332). The 5-year number needed to screen to prevent 1 HF event was similar across 2-step screening strategies (45\u201361). However, the number of tests and associated costs were lowest for WATCH-DM\/NT-proBNP ($1061) compared with other 2-step screening strategies (NT-proBNP\/hs-cTn: $2894; NT-proBNP\/echo-DbCM: $16\u2009358).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Selective NT-proBNP testing based on the WATCH-DM score efficiently identified a high-risk primary prevention population with diabetes expected to derive marked absolute benefits from SGLT2i to prevent HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.123.067530","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T14:15:06Z","timestamp":1699712106000},"page":"293-304","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Optimal Screening for Predicting and Preventing the Risk of Heart Failure Among Adults With Diabetes Without Atherosclerotic Cardiovascular Disease: A Pooled Cohort Analysis"],"prefix":"10.1161","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2002-4096","authenticated-orcid":true,"given":"Kershaw V.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Cardiology, Houston Methodist DeBakey Heart &amp; Vascular Center, TX (K.V.P., K.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6100-0897","authenticated-orcid":true,"given":"Matthew W.","family":"Segar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Texas Heart Institute, Houston (M.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6394-6862","authenticated-orcid":true,"given":"David C.","family":"Klonoff","sequence":"additional","affiliation":[{"name":"Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA (D.C.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1250-6351","authenticated-orcid":true,"given":"Muhammad Shahzeb","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University School of Medicine, Durham, NC (M.S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Shariq","family":"Usman","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.S.U., A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1903-0018","authenticated-orcid":true,"given":"Carolyn S.P.","family":"Lam","sequence":"additional","affiliation":[{"name":"National Heart Centre Singapore, Duke-National University of Singapore (C.S.P.L)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-8533","authenticated-orcid":true,"given":"Subodh","family":"Verma","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, St Michael\u2019s Hospital, University of Toronto, Canada (S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P.","family":"DeFilippis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (A.P.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5376-2269","authenticated-orcid":true,"given":"Khurram","family":"Nasir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Houston Methodist DeBakey Heart &amp; Vascular Center, TX (K.V.P., K.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-6791","authenticated-orcid":true,"given":"Stephan J.L.","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (S.J.L.B., R.P.F.D.), University Medical Center Groningen, University of Groningen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-7019","authenticated-orcid":true,"given":"B. 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