Article Text

other Versions

PDF
Elevated Glycated Haemoglobin is a Strong Predictor of Mortality in Patients with Left Ventricular Systolic Dysfunction who are not receiving treatment for Diabetes Mellitus
  1. Kevin M Goode (kevin.goode{at}hey.nhs.uk)
  1. University of Hull, United Kingdom
    1. Joseph John
    1. University of Hull, United Kingdom
      1. Alan S Rigby
      1. University of Hull, United Kingdom
        1. Eric S Kilpatrick
        1. Hull Royal Infirmary, United Kingdom
          1. Steve Atkin
          1. Hull York Medical School, United Kingdom
            1. Thanjuvar Bragadeesh
            1. University of Hull, United Kingdom
              1. Andrew L Clark
              1. University of Hull, United Kingdom
                1. John G F Cleland
                1. University of Hull, United Kingdom

                  Abstract

                  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.

                  Statistics from Altmetric.com

                  Request permissions

                  If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.