Impact of Hypoglycemia at the Time of Hospitalization for Heart Failure from Emergency Department on Major Adverse Cardiovascular Events with and without Type 2 Diabetes.

Background: Very few studies have examined the association between hypoglycemic episodes in type 2 diabetes (T2DM) and cardiovascular outcomes at the time of hospitalization for heart failure (HF) with or without T2DM.Methods: From March 2016 to June 2018, we conducted a retrospective cohort study to investigate hypoglycemia during HF hospitalization from the emergency department (ED), three-point major adverse cardiovascular events (3P-MACE) and all-cause mortality and followed up through June 2021. HF hospitalization was defined according to the American Hospital Association criteria. Hypoglycemia was defined as a glucose level <3.9 mmol/L at the time of HF hospitalization. We classified the enrolled patients according to hypoglycemia and T2DM into three groups (group 1, those without T2DM; group 2, those diagnosed with T2DM without hypoglycemia; and group 3, those with hypoglycemia and T2DM). We used Cox proportional hazard regression analysis to investigate the association between the three groups and the development of the first occurrence of 3P-MACE and all-cause mortality.Results: During a median of 25 months follow-up, a total of 783 patients admitted due to HF were analyzed. In total, 159 (20.3%) cases of 3P-MACE were identified, and the mortality rate was 20.2% (n = 158). The mean age of the patients was 72.3 ± 13.8 years, and 49.0% were men. Patients with 3P-MACE had a lower body mass index (22.6 [20.4–25.1] vs. 23.8 [21.3–26.7]), higher frequency of previous history of HF (24.5% vs. 15.7%), T2DM (64.2% vs. 47.3%), higher rates of hypoglycemia at the time of HF hospitalization (19.5% vs. 7.7%), as well as lower eGFR level (61.1 [36.0–80.7] mL/min/1.73 m2 vs. 69.2 [45.8–89.5] mL/min/1.73 m2) than those without 3P-MACE. The multivariable adjusted HR of 3P-MACE was group 3 HR, 2.29; 95% CI, 1.04–5.06; group 2, HR: 1.42; 95% CI: 0.86–2.33; and all-cause mortality group 3; HR: 2.58; 95% CI: 1.26–5.31, group 2; HR: 1.32; 95% CI: 0.81–2.16; compared to group 1.Conclusions: T2DM and hypoglycemia are independent risk factors for 3P-MACE and all-cause mortality compared to those without hypoglycemia during HF hospitalization.