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Nature and prognostic importance of abnormal glucose tolerance and diabetes in heart failure
  1. Colin Berry (colin.berry{at}clinmed.gla.ac.uk)
  1. Western Infirmary, Glasgow, United Kingdom
    1. John Norrie (j.norrie{at}abdn.ac.uk)
    1. Health Services Research Unit, Aberdeen University, United Kingdom
      1. Michael Brett (michaeljbrett{at}yahoo.com)
      1. Western Infirmary, Glasgow, United Kingdom
        1. Karen Stevenson (karensara77{at}hotmail.com)
        1. Western Infirmary, Glasgow, United Kingdom
          1. John J V McMurray (j.mcmurray{at}bio.gla.ac.uk)
          1. Western Infirmary, Glasgow, United Kingdom

            Abstract

            Objective We investigated 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 Four hundred and fifty four consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. Three hundred and ninety (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 iV 10.99 mmol/L), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/L). Fifty one (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 - 34.00; P=0.046) but not diabetes (HR 3.46, 0.75 - 16.02; P=0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632 &iV 978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes died, respectively (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 - 2.16); P=0.12) and diabetes (adjusted HR: 2.02 (1.41 iV 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, 1.13) P=0.001, which after adjustment for the above covariates became 1.08 (1.03, 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.

            • diabetes
            • glucose
            • heart failure
            • prognosis

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