Glycosylated haemoglobin assessment in diabetic patients with acute coronary syndromes
1Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
Insights
Glycosylated haemoglobin (HbA1c) testing for diabetic patients with acute coronary syndromes (ACS) varied significantly across Australian hospitals. While HbA1c assessment correlated with better medical care, it did not impact 6-month mortality.
Area of Science:
- Cardiology
- Diabetology
- Health Services Research
Background:
- Guidelines recommend optimal glycaemic control for diabetic patients with acute coronary syndromes (ACS).
- Glycosylated haemoglobin (HbA1c) is a key marker for monitoring long-term glycaemic control in diabetes.
Purpose of the Study:
- To determine the frequency and predictors of in-hospital HbA1c measurement in diabetic ACS patients.
- To assess the relationship between HbA1c assessment and post-discharge mortality.
Main Methods:
- A registry-based cohort study of 1743 diabetic patients with ACS from 33 Australian hospitals.
- Multivariable logistic generalized estimating equations and Cox proportional hazard analyses were used.
Main Results:
- Only 41% of patients received HbA1c assessment, with significant inter-hospital variation (7.7-87.6%).
- Assessment was more common in hospitals with catheterisation labs and associated with younger age, STEMI, cardiac catheterisation, and bypass surgery.
- HbA1c assessment correlated with increased coronary catheterisation, revascularisation, and evidence-based medicine use, but not 6-month mortality.
Conclusions:
- Hospital-based HbA1c assessment frequency for diabetic ACS patients in Australia is highly variable.
- Most diabetic ACS patients do not undergo pre-admission glycaemic control assessment.
- HbA1c assessment is linked to superior evidence-based medical management.
Background:
Guidelines for the management of acute coronary syndromes (ACS) advocate for maintaining adequate long-term glycaemic control in diabetic patients. Glycosylated haemoglobin (HbA1c) measurement is commonly used to monitor long-term glycaemic control in diabetes.
Aims:
To evaluate the frequency and clinical predictors of in-hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge.
Methods:
This registry-based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS. Independent predictors of HbA1c assessment were evaluated using a multivariable logistic generalised estimating equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis.
Results:
Seven hundred and fourteen (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7-87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, ST-Elevation Myocardial Infarction, cardiac catheterisation and coronary artery bypass surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence-based medicines but not with mortality during 6 months following discharge (hazard ratio, 0.48; 95% confidence interval, 0.19-1.18).
Conclusion:
Frequency of HbA1c assessment varies markedly between hospitals, and most diabetic patients admitted for ACS in Australia do not receive assessment of pre-admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care.
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