Article

Implementation of CVD risk assessment in people with diabetes in India

Published on September 25, 2024 | 11 min read
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Key takeaways

  • For T2DM patients, NT-proBNP testing can provide valuable information on the risk of developing heart failure and can aid in informed shared decision-making.
  • In cases of physician-patient communication challenges, NT-proBNP testing allows the clear and quick exchange on the basis of a single cut-off value.
  • In Dr. Kalra's practice, routine NT-proBNP testing of T2DM patients asymptomatic for heart failure allowed the identification of 15% high risk cases. These patients could be promptly referred to cardiologists for further investigation and treatment.

Medical communication strategies improving the implementation of CVD risk assessment in T2D patients

Dr. Kalra presents learnings from his practice at Bharti Hospital on the various needs of patients during the management of diabetes mellitus type 2 (T2DM), with a focus on cardiovascular disease CVD risk assessment. He explores a number of culturally-relevant medical communication practices that help build trust between healthcare professionals (HCPs) and patients, and how these educational efforts result in the implementation of guideline-recommended screening by natriuretic peptide testing (e.g. NT-proBNP), and improved patient outcomes.

Based on the experience in his practice, Dr. Kalra remarks that patients primarily seek symptomatic control, followed by effective glycemic control. Only when the acute phase is surpassed, the focus can shift towards preventative measures in managing cardiovascular risks.

NT-proBNP testing is an established tool for the diagnosis of heart failure (HF)1,2 and, in diabetes mellitus patients, can be used both to diagnose HF in the presence of symptoms3 and to assess the risk of HF development in asymptomatic patients.4 According to Dr. Kalra, if used effectively, NT-proBNP testing can serve as a means to motivate patients towards treatment adherence and aid in informed and shared decision making.

Efficient solutions found in Prof. Kalra's practice on how to use NT-proBNP testing as a valuable patient-education tool

  1. Language: a large number of languages are spoken in India (nearly 800), and conveying complex test results in multiple languages can become challenging. NT-proBNP testing allows the clear and quick communication of a single cut-off value. Patients with NT-proBNP values >125 pg/mL are informed that there is higher use of medication needed and/or referral to a cardiologist.
  2. High number of tests: diabetes patients are often reluctant towards the addition of supplementary blood tests. In these cases, several creative communication approaches are used by making analogies familiar in the cultural background of patients in order to explain in lay terms the importance and value of biomarkers that can help predict their future health status

Dr. Kalra further highlights the importance of the work of paramedic staff who play a crucial role for the medical education of patients in a non-anxiety producing manner. Diverse communication strategies are explored and shared as brochures, posters, and other supplementary materials using a variety of analogies from everyday life. The result of these efforts is that within Dr. Kalra’s practice about 15% of T2D patients, who were asymptomatic for HF and had high NT-proBNP levels, could be referred to a neighbouring cardiology hospital in a timely manner. Dr. Kalra reported that the use of NT-proBNP testing has allowed informed decision making on the future course of treatment between the physician team (general practitioners and cardiologists) and the patients.

Watch the video to learn about a number of communication tools developed by the Bharti Hospital staff that help simplify medical terms and support the implementation of NT-proBNP screening for patients living with T2D in order to improve their risk assessment for cardiovascular diseases and allow for early detection of HF development as recommended by the American Diabetes Association.2

Chronic Disease Management Programme for early detection of heart failure in people living with diabetes

Chronic Disease Management Programme (CDM) Ireland

for early detection of heart failure in people living with diabetes, Prof. McDonald.

Prof Pop Busui Clinical implementation of routine heart failure screening for patients living with T2D

Clinical implementation of routine heart failure screening

for patients living with T2D, USA, Prof. Pop-Busui.

 

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References

  1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Oct 14;: PMID: 34447992.
  2. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-e421. doi: 10.1016/j.jacc.2021.12.012. Epub 2022 Apr 1. Erratum in: J Am Coll Cardiol. 2023 Apr 18;81(15):1551. doi: 10.1016/j.jacc.2023.03.002. PMID: 35379503.
  3. Marx N, Federici M, Schütt K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes [published correction appears in Eur Heart J. 2023 Dec 21;44(48):5060. doi: 10.1093/eurheartj/ehad774] [published correction appears in Eur Heart J. 2024 Feb 16;45(7):518. doi: 10.1093/eurheartj/ehad857]. Eur Heart J. 2023;44(39):4043-4140.
  4. American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S179–S218.