NT-proBNP-guided virtual CKM strategy significantly boosts SGLT2i and finerenone prescriptions in T2DM patients

Adults with type 2 diabetes mellitus (T2DM) face a substantially elevated risk for developing heart failure (HF), yet the prescription rates for crucial preventive therapies remain low. This gap in care contributes to significant morbidity and mortality. Current standard-of-care often overlooks early identification of high-risk individuals for HF prevention. This study addresses the need for a more proactive, risk-based approach to identify and manage T2DM patients at high risk for HF, leveraging biomarkers like N-terminal pro-B-type natriuretic peptide (NT-proBNP) to guide targeted interventions and improve the uptake of cardio-kidney-metabolic (CKM) protective therapies.

This pilot study evaluated a virtual CKM prevention strategy in T2DM patients without prior HF. The intervention included primary care physician (PCP) education, electronic health record-based recommendations for NT-proBNP screening, and virtual CKM consultations. Patients were identified as high-risk for HF if their WATCH-DM score was ≥12 or NT-proBNP was ≥125 pg/mL. The study included 545 patients (62.4% women; 33.6% Black). Key outcomes were new prescription rates of CKM therapies (sodium-glucose cotransporter 2 inhibitors, glucagon-like-peptide-1 receptor agonists, or finerenone) over a 6-month follow-up, compared between the intervention group and a retrospectively matched control group (matched for age, sex, race, CKM risk factors, and existing CKM therapies) from nonparticipating PCPs.

The virtual CKM prevention strategy significantly improved the prescription of guideline-recommended therapies. PCPs ordered NT-proBNP screening in 93.4% of intervention patients, identifying 36.9% as high-risk for HF. Notably, NT-proBNP screening alone identified an additional 16.7% of patients as high-risk who were deemed low-risk by the WATCH-DM score. Over a 180-day median follow-up, the intervention group showed significantly greater new prescriptions compared to the matched control group:

New sodium-glucose cotransporter 2 inhibitor prescriptions increased to 20.3% in the intervention group vs. 5.8% in controls (P < 0.001). Finerenone prescriptions also saw a substantial rise, reaching 4.1% in the intervention group compared to just 0.2% in controls (P < 0.001). However, there was no significant difference in the initiation of glucagon-like-peptide-1 receptor agonists between the groups. These findings highlight the effectiveness of a risk-based, biomarker-guided approach in driving the adoption of critical preventive medications.