Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus

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 who started diabetic medication in the subsequent 12 months, which might influence HbA1c, were excluded. FINDINGS: Of 970 non-diabetic patients referred between 2001 and 2004, the median age was 72 years (range 25 to 96 years), 56% were men, 45% had left ventricular ejection fraction (LVEF) 6% (upper reference limit). Among patients with LVEF 6.7% (n = 68) compared with those with HbA1c 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 <or=45% which could help improve clinical management.