Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes

Maneesh Sud, Xuesong Wang, Peter C. Austin, Lorraine L. Lipscombe, Gary E. Newton, Jack V. Tu, Ramachandran S. Vasan, Douglas S. Lee

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)924-931
Number of pages8
JournalEuropean Heart Journal
Volume36
Issue number15
DOIs
StatePublished - Apr 14 2015
Externally publishedYes

Keywords

  • Blood glucose
  • Complications
  • Diabetes
  • Heart failure
  • Hospitalization
  • Morbidity
  • Mortality
  • Outcomes
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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