The prospective trial demonstrated that systematic natriuretic peptide screening, followed by echocardiography for elevated levels, successfully uncovered predominantly preserved ejection fraction heart failure (HFpEF) that routine care missed.
The TARTAN-HF Trial Design and Patient Population
Led by investigator Daniel Taylor-Sweet, MBChB, and colleagues, the prospective, unblinded trial randomized 706 participants across West Scotland. Participants were aged 40 or older with a median age of 71 years, and 31% were women. All enrollees had either type 1 diabetes (10%) or type 2 diabetes (90%), alongside at least one additional cardiovascular risk factor.
Qualifying risk factors in the cohort included chronic kidney disease (present in 57% of participants), coronary artery disease (39%), persistent or permanent atrial fibrillation, previous ischemic or embolic stroke, peripheral artery disease, regular loop diuretic use exceeding 30 days, and chronic obstructive pulmonary disease. Investigators noted that 26% of participants carried two risk factors, while 10% had three or more.
Screening Protocol and Diagnostic Yield
Patients in the trial were assigned on a 1:1 basis to either usual care or an NT-proBNP screening strategy. In the screening arm, participants underwent NT-proBNP sampling. Those with levels registering 125 pg/mL or higher—representing about half of the screened group—were referred for clinical review and echocardiography. Per 2021 European Society of Cardiology criteria, the primary outcome measured a new heart failure diagnosis at six months, requiring clinical signs or symptoms, an elevated NT-proBNP threshold, and echocardiographic evidence of structural remodeling or high filling pressures.
At nearly 18 months of follow-up, 25% of the screening group received a new heart failure diagnosis, compared with just 1% of the usual care arm, yielding an odds ratio of 58. The number needed to screen to find one case was exceptionally low at just 5. The vast majority of these newly diagnosed cases were HFpEF, accounting for 23% of the screened cohort, while heart failure with reduced ejection fraction (HFrEF) and mildly reduced ejection fraction (HFmrEF) each accounted for less than 1%.
Clinical Impact and Therapeutic Changes
Patients with unrecognized heart failure reported severely impaired health status at baseline compared to those without the condition, registering a median Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score of 65.6 versus 89.6. The most common symptoms reported were breathlessness at 84%, fatigue at 53%, and ankle edema at 53%.
Within the screening arm, use of sodium-glucose cotransporter-2 (SGLT2) inhibitors increased from a baseline of 24% to 39% overall, and nearly doubled from 21% to 72% specifically among patients diagnosed with HFmrEF or HFpEF through the pathway. Loop diuretic utilization also climbed in the screening group, whereas the usual care arm saw no significant changes in medication patterns.
Furthermore, an exploratory composite outcome of heart failure hospitalization or all-cause death showed a 55% relative risk reduction in the screening arm compared with usual care, driven primarily by a significant reduction in all-cause mortality, according to trial data published in JACC.
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