Background: Glycated haemoglobin (HbA1c) is an indicator of average blood glucose concentrations over the preceding 3 months, is simpler to perform than either a fasting glucose or glucose tolerance test and is associated with a worse prognosis in some clinical settings. However its relationship to survival in patients with suspected heart failure has not been studied.
Methods: Patients referred to a community-based heart failure clinic with suspected heart failure had a comprehensive assessment including the measurement of HbA1c. For this analysis, patients with DM or initiation of diabetic medication in the subsequent 12-months, which might influence HbA1c, were excluded.
Findings: Of 970 non-diabetic patients referred between 2001-2004, the median age was 72 years (range 25-96 years), 56% were men, 45% had left ventricular ejection fraction (LVEF) ≤45% and 50% had an HbA1c >6% (upper reference limit). Amongst patients with LVEF ≤45% there was an abrupt increase in mortality in those with an HbA1c >6.7% (n=68) compared to those with HbA1c ≤6.7% (n=368) (hazard ratio (HR): 2.4, p<0.001) and this persisted after adjustment for age and co-morbidity (HR 1.9, p=0.008); respective one year mortalities were 26.5% and 9.4%. This increase in mortality was not seen in those with LVEF >45% (HR 1.44, p=0.36 after adjustment).
Interpretation: The abrupt increase in mortality with HbA1c may make it a useful risk stratification tool in non-diabetic patients with LVEF ≤45% which could help improve clinical management.
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