Use of strain imaging to guide primary heart failure prevention in older asymptomatic patients with type 2 diabetes appears to be a cost-saving approach, according to new data presented at the American College of Cardiology’s (ACC) 65th Annual Scientific Session.
Asymptomatic left ventricular dysfunction, a precursor of heart failure in patients with type 2 diabetes, is identifiable with echocardiography (echo), according to the researchers. They theorized that screening and early intervention for left ventricular dysfunction could reduce the frequency of heart failure.
The team assessed the cost-effectiveness of usual care, screening and early intervention of left ventricular dysfunction, and uniform use of cardioprotective therapy in adults aged 65 and older with type 2 diabetes.
“We all know that diabetes is a high risk factor for heart failure, but diabetes patients are not routinely screened. So, we were wondering whether prevention based on screening for all elderly diabetes patients in community is cost effective or not,” said lead study investigator Ying Wang, a PhD candidate at the Menzies Institute for Medical Research in Hobart, Australia.
For this investigation, a Markov model with annual cycle and a 10-year horizon was developed to compare the costs and quality-adjusted life years (QALYs) of usual care. This was compared to the same model for primary prevention with an aldosterone antagonist and prevention guided by screening of left ventricular dysfunction with global longitudinal strain (GLS) in older patients with type 2 diabetes. The investigators used a US health care payer perspective, and transition probabilities, costs, and utilities were based on the literature and other factors.
The researchers found that GLS-guided prevention resulted in higher QALYs than primary prevention (6.43 vs 6.28 QALYs). In addition, the costs were lower with GLS-guided prevention compared with usual care ($55 484 vs $59 470). The study showed that the projected 10-year survival was 82% with normal GLS, 70% for treated abnormal GLS and primary prevention, 67% for untreated abnormal GLS, and 66% for usual care. Patients who received the aldosterone antagonist spironolactone had the greatest benefits.
“Overall, we found that giving spironolactone to type 2 diabetes patients based on GLS is not just cost-effective, it is cost-saving. It means this strategy could give type 2 diabetes patients better quality of life and less cost,” said Wang. “If we could initiate the preventive medication to screen selected high-risk type 2 diabetes patients, we could save more money and more lives. However, if we want to put this into clinical practice, we still need more results from randomized controlled studies,” Wang told Endocrinology Advisor.
Therefore, more research is warranted, he said, but even so, clinicians may want to think about swapping out the usual care model with imaging and therapy.
“I think choosing target patients who are at high risk to prevent heart failure is really important for endocrinologists. Asymptomatic type 2 diabetes patients have a high prevalence of subclinical left ventricular dysfunction, which could be a precursor of heart failure. This study provides endocrinologists preliminary results showing that there are effective screening tools to detect subclinical left ventricular dysfunction in diabetes patients and there is effective preventive medication to prevent HF,” said Wang.
- Wang Y, Marwick T. Cost-Effectiveness of Myocardial Imaging to Identify Subclinical Left Ventricular Dysfunction in Elderly Patients With Asymptomatic Type 2 Diabetes. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.