Log in to MyACC
Presentation Blood Glucose and Death, Hospitalization, and Future Diabetes Risk in Patients With Acute Heart Failure Syndromes | Journal Scan
Study Questions:
What are the prognostic implications of blood glucose on early mortality, hospitalizations, and incident diabetes diagnoses in acute heart failure syndromes (AHFS)?
Methods:
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.
Results:
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).
Conclusions:
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.
Perspective:
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
< Back to Listings
