The Impact of Diabetes Control on Outcomes in Patients with Left Ventricular Assist Devices

Abstract

<h3>Purpose</h3> Diabetes mellitus is a risk factor for morbidity and mortality in patients with heart failure. The effect of pre-implant diabetes control on left ventricular device (LVAD) outcomes and specific types of infection is unclear. Prior studies have found that diabetes is associated with an increased rate of all-cause mortality and major adverse events during LVAD support, while others have shown that diabetes is not associated with major adverse events, including infections. The purpose of our study was to understand the relationship of pre-LVAD hemoglobin A1c on post implant infection. <h3>Methods</h3> We analyzed 2054 patients from the INTERMACs registry who were implanted with an LVAD and had a hemoglobin A1c level checked between Jan 2016-Dec 2017. The association between pre-implantation hemoglobin A1c and post-implant infection within 90 days was assessed using a cox proportional hazards model. <h3>Results</h3> Pre-implant hemoglobin A1c levels had no significant association with post-LVAD infections within 90 days of follow-up (HR 1.02 [95% CI 0.96-1.09], p 0.544). Furthermore, this lack of association did not vary within subgroups of infection type (driveline, bloodstream, pulmonary, or urinary tract). (Figure 1) <h3>Conclusion</h3> Based on this large database, pre-LVAD hemoglobin A1c is not a predictor of early post-LVAD infection. Further studies are needed to better understand the relationship of hemoglobin A1c as it relates to clinical outcomes after LVAD implantation.