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Glycated Hemoglobin and Outcomes of Heart Failure (from Get With the Guidelines-Heart Failure)

Justin B Echouffo-Tcheugui1, Shubin Sheng2, Adam D DeVore2

  • 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The American Journal of Cardiology
|December 17, 2018
PubMed

Insights

Glycated hemoglobin (HbA1C) impacts heart failure (HF) patient outcomes, increasing hospital stay length and home discharge likelihood. However, HbA1C levels did not significantly affect mortality or readmission rates in this study.

Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Glycated hemoglobin (HbA1C) is a known risk factor for new-onset heart failure (HF).
  • Limited data exist on HbA1C's association with outcomes in patients with established HF.
  • Understanding this relationship is crucial for managing HF patients, particularly those with diabetes.

Purpose of the Study:

  • To assess the association between HbA1C levels and various clinical outcomes in hospitalized patients with established HF.
  • To investigate whether HbA1C influences in-hospital mortality, length of stay, discharge disposition, and post-discharge mortality and readmission.
  • To stratify analyses by diabetes status to understand its role in the HbA1C-outcome relationship.

Main Methods:

  • Retrospective analysis of 41,776 hospitalized HF patients from the Get with the Guidelines-HF registry (2009-2016).
  • HbA1C levels were related to outcomes including in-hospital mortality, length of stay, discharge to home, 30-day mortality/readmission, and 1-year mortality.
  • Generalized estimating equations were used to account for within-hospital clustering and potential confounders.

Main Results:

  • A significant association was found between higher HbA1C levels and increased odds of discharge to home.
  • Patients in the highest HbA1C tertile (≥7.3%) had a longer hospital stay (>4 days) and higher odds of discharge home compared to the lowest tertile (≤6.1%).
  • No significant associations were observed between HbA1C levels and in-hospital mortality, 30-day mortality, 30-day readmission, or 1-year mortality.

Conclusions:

  • In hospitalized HF patients, HbA1C levels are associated with prolonged hospital stay and a higher likelihood of discharge to home.
  • These associations were particularly evident among patients with diabetes.
  • HbA1C levels did not appear to be significantly associated with short-term or intermediate-term mortality or readmission in this cohort.

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