Diagnostic tool doubles cardiovascular diagnoses in patients with COPD or diabetes

An easy-to-use diagnostic strategy more than doubled the number of new diagnoses of cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD) or type 2 diabetes. According to the authors, this diagnostic tool should be implemented in the management of patients with these conditions.

“Up to 40% of the patients with COPD or type 2 diabetes have unknown but treatable CVD,” outlined Dr Amy Groenewegen (University Medical Center Utrecht, the Netherlands) [1]. “These patients are often symptomatic.” To reveal CVD at an early stage in this population, Dr Groenewegen and colleagues evaluated a diagnostic strategy in primary care patients with COPD and/or type 2 diabetes.

The RED-CVD trial was a cluster-randomised trial including 25 practices and 1,216 participants [2]. The diagnostic intervention was a stepwise approach, starting with a symptom questionnaire, followed by step 2, a physical exam, NT-proBNP, and ECG evaluations, and step 3, a referral. The primary outcome measure was newly detected CVD, including atrial fibrillation, heart failure, and coronary artery disease at 1 year of follow-up.

In the usual-care arm, 3.0% of the participants were diagnosed with a new CVD compared with 8.0% in the intervention arm (OR 2.83; 95% CI 1.62–4.95) [1]. Dr Groenewegen added that this effect was mainly driven by an increase in diagnoses of heart failure with preserved ejection fraction (3.2% vs 0.7%), atrial fibrillation (2.1% vs 0.8%), and relevant non-obstructive coronary artery disease (1.3% vs 0.2%) in the intervention arm.

The questionnaire showed that 70% of the participants reported having symptoms. Of the participants that continued to the next step, 25% had abnormalities in the physical exam, 10% had abnormalities on ECG, and 26% had newly elevated NT-proBNP levels. In total, 239 of the 607 participants (39%) in the intervention arm were referred based on abnormal findings in step 2.

“This easy-to-use diagnostic strategy led to a significant increase in diagnoses of new CVD in patients with COPD and/or type 2 diabetes, and should be considered to be implemented in the management of these patients in the primary care setting,” concluded Dr Groenewegen.

1. 
   
   1. Boonman-de Winter LJM, et al. Eur J Heart Fail. 2015;17(2):187–195.
   2. Groenewegen A, et al. RED-CVD: reviving early diagnosis of cardiovascular disease: a cluster-randomised diagnostic trial. Hot Line Session 8, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.

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Posted on 30 October 2023