Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) in community settings often precedes confirmed diagnosis of heart failure (HF). Delays in echocardiography may leave high-risk patients untreated during a vulnerable period. This analysis published in the European Heart Journal assessed whether early initiation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and/or mineralocorticoid receptor antagonists (MRA) at the time of NT-proBNP elevation could reduce early adverse outcomes in patients with suspected HF.

Using linked primary and secondary care data from the Clinical Practice Research Datalink (January 2015-March 2023), adults without prior HF and not already receiving SGLT2i or MRA were followed for 12 months after a community-measured NT-proBNP ≥400 pg/mL. The primary outcome was a composite of HF hospitalization as the first recorded HF diagnostic event or all-cause death among patients without a documented HF diagnosis who did not undergo echocardiography during follow-up. Treatment effects were modeled using risk reductions from meta-analyses of randomized placebo-controlled trials in established HF among patients with pre-existing non-HF indications.

Of these, 15,398 (64%) were diagnosed in outpatient settings and 8,684 (36%) during HF hospitalization. Modeling suggested that initiating both SGLT2i and MRA at NT-proBNP elevation could prevent 84 HF hospitalizations or deaths per 1,000 treated patients at 12 months (number needed to treat 12; 95% CI 11-14).

Early initiation of SGLT2i and MRA in eligible patients with elevated NT-proBNP may reduce early adverse outcomes while awaiting diagnostic confirmation. These findings suggest a potential clinical strategy with public health implications.