Abstract
BackgroundComorbid diabetes is common in heart failure and associated with increased hospitalization and mortality. Nonetheless, the association between glycemic control and outcomes among patients with heart failure and diabetes remains poorly characterized, particularly among low income and minority patients.MethodsWe performed a retrospective cohort study of outpatients with heart failure and diabetes in the New York City Health and Hospitals Corporation, the largest municipal health care system in the United States. Cox proportional hazard models were used to measure the association between HbA1c levels and outcomes of all-cause hospitalization, heart failure hospitalization, and mortality.ResultsOf 4723 patients with heart failure and diabetes, 42.6 % were black, 30.5 % were Hispanic/Latino, 31.4 % were Medicaid beneficiaries and 22.9 % were uninsured. As compared to patients with an HbA1c of 8.0–8.9 %, patients with an HbA1c of <6.5, 6.5–6.9, 7.0–7.9, and ≥9.0 % had an adjusted hazard ratio (aHR) (95 % CI) for all-cause hospitalization of 1.03 (0.90–1.17), 1.05 (0.91–1.22), 1.03 (0.90–1.17), and 1.13 (1.00–1.28), respectively. An HbA1c ≥ 9.0 % was also associated with an increased risk of heart failure hospitalization (aHR 1.33; 95 % CI 1.11–1.59) and a non-significant increased risk in mortality (aHR 1.20; 95 % CI 0.99–1.45) when compared to HbA1c of 8.0–8.9 %.ConclusionsAmong a cohort of primarily minority and low income patients with heart failure and diabetes, an increased risk of hospitalization was observed only for an HbA1c greater than 9 %.
Highlights
Comorbid diabetes is common in heart failure and associated with increased hospitalization and mortality
In this cohort of patients with heart failure and diabetes from a diverse, urban, and primarily lowincome hospital system, we found no difference in risk of hospitalization or mortality for hemoglobin A1c (HbA1c) levels up to 8.9 %
Hospitalization risk only increased at the highest HbA1c level; an HbA1c of 9.0 % or higher was associated with a 13 % increase in the relative hazard of all-cause hospitalization and a 33 % increase in the relative hazard of heart failure hospitalization when compared to lower HbA1c
Summary
Comorbid diabetes is common in heart failure and associated with increased hospitalization and mortality. The association between glycemic control and outcomes among patients with heart failure and diabetes remains poorly characterized, among low income and minority patients. Despite the increased risk of poor outcomes among patients with heart failure and diabetes, the optimal hemoglobin A1c (HbA1c) level for patients with heart failure and diabetes remains uncertain. Elevated levels of HbA1c have been associated with increased risk for heart failure related hospitalizations [13,14,15,16], intervention trials in patients with Type 2 diabetes have failed to show benefit with tight glycemic control and some studies have even suggested harm [17,18,19]. Tight glycemic control could predispose to volume retention in heart
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
