HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) All Versions of this Article: hrt.2006.110999v1 94/3/296    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Berry, C Articles by Norrie, J Search for Related Content PubMed PubMed Citation Articles by Berry, C Articles by Norrie, J

Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure

¹ Department of Cardiology, Western Infirmary, Glasgow, Scotland
² Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland

Correspondence to:
Professor John J V McMurray, MD FRCP FESC FACC FAHA, Department of Cardiology, Western Infirmary, Glasgow and Faculty of Medicine, University of Glasgow, Glasgow G11 6NT, United Kingdom; j.mcmurray{at}bio.gla.ac.uk

Objective: To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.

Design: Cohort study.

Setting: Urban University hospital.

Patients: All index emergency HF admissions to one University hospital during the year 2000 were studied.

Results: 454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital. After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632–978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075). Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023.

Conclusions: Admission blood glucose concentration and diabetes are prognostically important in HF and could help target some patients for more intensive therapy.

Keywords: heart failure; glucose; diabetes; prognosis