January 8, 2015European Heart Journal
Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes
Figures
Why the study?
The prognostic implications of blood glucose on early mortality, hospitalizations, and incident diabetes had not been fully elucidated in acute heart failure syndromes.
Does elevated presentation blood glucose predict early death, hospitalizations, and future diabetes in patients with acute heart failure syndromes?
Structured PICO
Does elevated presentation blood glucose predict early death, hospitalizations, and future diabetes in patients with acute heart failure syndromes?
P
Population
16,524 patients with acute heart failure syndromes (AHFS) presenting to the emergency department in Ontario, Canada between 2004 and 2007 (9,275 without diabetes, 7,249 with diabetes).
I
Intervention
Elevated presentation blood glucose concentrations (>6.1-7.8, >7.8-9.4, >9.4-11.1, and >11.1 mmol/L)
C
Comparator
Presentation blood glucose 3.9-6.1 mmol/L (referent)
O
Outcome
30-day mortality, new diabetes diagnoses, and hospitalization outcomes (diabetes-related, HF, or cardiovascular causes)hard clinical
Mildly elevated presentation blood glucose in acute heart failure patients is a significant prognostic marker for early mortality, future diabetes, and hospitalizations, regardless of prior diabetes status.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Among patients without pre-existing diabetes, the majority (51%) had blood glucose levels on arrival at hospital that were within 'normal' limits but greater than 6.1 mmol/L. Our results suggest that all such patients should undergo further testing for diabetes before discharge. If the hospital tests show that their fasting blood glucose is not elevated, then they should be monitored subsequently for the development of diabetes as outpatients.”
“If blood glucose measurement is prognostically useful, it may be of broad potential utility because it is a rapid, readily available, and inexpensive test that can be used in the acute setting to allow rapid risk stratification for a wide range of potential outcomes.”
Implication
Elevated glucose marks higher-risk AHFS patients but should not change practice; leaves open benefit of glucose-lowering RCTs.
Abstract
PURPOSE: The prognostic implications of blood glucose on a wide range of outcomes including early mortality, hospitalizations, and incident diabetes diagnoses have not been fully elucidated 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, we 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 = 9275), blood glucose >6.1 mmol/L (n = 5252, 56.6%) was associated with increased risks of all-cause death [hazard ratio (HR) range: 1.26 (95% CI 1.05-1.50) to 1.50 (95% CI 1.11-2.02)], and cardiovascular death [HR range: 1.28 (95% CI 1.03-1.59) to 1.64 (95% CI 1.16-2.33)]. Among AHFS patients with diabetes (n = 7249), presenting blood glucose >11.1 mmol/L (n = 2286, 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: Mildly elevated presentation blood glucose was associated with early death, future diabetes, and hospitalizations for diabetes, HF, and cardiovascular causes among patients with AHFS.
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Cite This Study
Sud et al. (2015) studied this question.