Glycated Hemoglobin and Outcomes of Heart Failure (from Get With the Guidelines-Heart Failure).
Glycated hemoglobin (HbA1C) is a risk factor for new onset heart failure (HF). There is however a paucity of data evaluating its association with outcomes in patients with established HF. We assessed the relation of HbA1C with outcomes among hospitalized HF patients. Among 41,776 HF patients from 263 hospitals participating to the Get with the Guidelines-HF registry between January 2009 and March 2016, we related HbA1C to outcomes (in-hospital mortality, length of hospital stay, discharge to home, 30-day mortality, 30-day readmission, and 1-year mortality), using generalized estimating equation to account for within-hospital clustering and potential confounders. There were 68% of HF patients with diabetes and median HbA1C was 7.1%. Each percent change in HbA1C was associated with higher odds of discharge to home for HbA1C levels <6.5% (covariate-adjusted odds ratio [OR] 1.13 [95% confidence interval 1.04 to 1.12]) or ≥6.5% (OR 1.05 [1.02 to 1.07]). After stratification by diabetes status, this association remained significant only among patients with diabetes (ORs for HbA1C levels <6.5%: 1.17 [1.07 to 1.27]; and ≥6.5%: 1.06 [1.03 to 1.09]). Compared with the lowest HbA1C tertile (HbA1C ≤6.1%), patients in the highest HbA1C tertile (HbA1C 7.3% to 19%) were more likely to have a length of hospital stay >4 days (OR 1.10 [1.02 to 1.18]) and to be discharged home (OR 1.23 [1.14 to 1.33]). There were no significant association between HbA1C and the following outcomes: in-hospital mortality, 30-day mortality, 30-day readmission, and 1-year mortality. In conclusion, among hospitalized HF patients, HbA1C was associated with prolonged hospital stay and home discharge, but not with readmission, short-term, or intermediate-term mortality.
Echouffo-Tcheugui, JB; Sheng, S; DeVore, AD; Matsouaka, RA; Hernandez, AF; Yancy, CW; Heidenreich, PA; Bhatt, DL; Fonarow, GC
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