Presentation Blood Glucose and Death, Hospitalization, and Future Diabetes Risk in Patients With Acute Heart Failure Syndromes | Journal Scan
What are the prognostic implications of blood glucose on early mortality, hospitalizations, and incident diabetes diagnoses in acute heart failure syndromes (AHFS)?
In a population-based cohort of 16,524 AHFS patients presenting to the emergency department (ED) in Ontario, Canada between 2004 and 2007, the authors performed a competing risk analysis for 30-day mortality, new diabetes diagnoses, and hospitalization outcomes. Presentation blood glucose concentrations were categorized as follows: 3.9–6.1 [referent], >6.1–7.8, >7.8–9.4, >9.4–11.1, and >11.1 mmol/L.
Among AHFS patients without diabetes presenting to the ED (n = 9,275), blood glucose >6.1 mmol/L (n = 5,252, 56.6%) was associated with increased risks of all-cause death (hazard ratio [HR] range, 1.26; 95% confidence interval [CI], 1.05–1.50 to HR range, 1.50; 95% CI, 1.11–2.02), and cardiovascular death (HR range, 1.28; 95% CI, 1.03–1.59 to HR range, 1.64; 95% CI, 1.16–2.33). Among AHFS patients with diabetes (n = 7,249), presenting blood glucose 11.1 mmol/L (n = 2,286, 31.5%) was associated with increased risks of all-cause death (HR, 1.48; 95% CI, 1.10–2.00) and diabetes-related hospitalizations (HR, 1.39; 95% CI, 1.20–1.61). Presentation blood glucose >9.4 mmol/L was associated with increased risks of hospitalization for HF or cardiovascular causes (HR range, 1.09; 95% CI, 1.02–1.17) to 1.15 (95% CI, 1.07–1.24) in all patients. With higher presentation blood glucose, the risk of incident diabetes diagnosis increased, with adjusted HRs of 1.61 (>6.1–7.8 mmol/L) to 3.61 (>11.1 mmol/L) among those without the condition at baseline (all p < 0.001).
The authors concluded that mildly elevated presentation blood glucose was associated with early death, future diabetes, and hospitalizations for diabetes, HF, and cardiovascular causes among patients with AHFS.
This large, population-based cohort of patients presenting to an ED with AHFS reports that presentation blood glucose exceeding 11.1 mmol/L in patients with pre-existing diabetes was associated with increased risk of 30-day all-cause death and diabetes-related hospitalizations. In patients without pre-existing diabetes, the risks of 30-day all-cause and cardiovascular mortality were increased, beginning to rise within normoglycemia (>6.1 mmol/L). Furthermore, presentation blood glucose at the upper-end of normoglycemia was associated with over 1.6-fold risk of de-novo diabetes, whereas higher values conferred up to 4-fold risk of a new diabetes diagnosis in both men and women. The acute measurement of blood glucose at HF presentation may provide prognostic value and be a potential target to improve outcomes in patients with AHFS.
Keywords: Blood Glucose, Cause of Death, Diabetes Mellitus, Type 2, Emergency Service, Hospital, Heart Failure, Hospitalization, Hyperglycemia, Ontario, Risk
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