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Higher blood glucose levels may boost chances for survival in heart failure patients with diabetes
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Higher HbA1c levels were associated with improved survival rates in diabetes patients with advanced heart failure, according to data from a cohort study.
G. Sofia Tomova, BS, a medical student in the division of cardiology at the UCLA Geffen School of Medicine, and colleagues designed a cohort study that included 845 heart failure patients with (n=358) or without diabetes (n=487) to evaluate the relationship between HbA1c and heart failure.
“Despite the abundance of evidence linking [diabetes], insulin resistance, and hyperglycemia to impaired functional status and worse outcomes in patients with [heart failure], there is a lack of data and guidelines on optimal strategies to manage [diabetes] in patients with chronic [heart failure],” the researchers wrote.
They stratified patients with diabetes into four quartiles based on HbA1c: quartile 1, ≤6.4%; quartile 2, 6.5% to 7.2%; quartile 3, 7.3% to 8.5%; and quartile 4, ≥8.6%. Researchers concluded that 2-year event-free survival rates were 61% and 65% for patients in quartiles 1 and 2, respectively, compared with 48% and 42% for those in quartiles 3 and 4, respectively (P=.005).
Additionally, for every unit increase in HbA1c in patients with diabetes, there was a 15% decrease in risk for death or urgent heart transplantation (HR=0.85; 95% CI, 0.76-0.95), as well as a 15% decrease in risk for all-cause mortality (HR=0.85; 95% CI, 0.74-0.99).
Compared with quartile 4, patients in quartiles 1 and 3 were at higher risk for death or urgent heart transplantation (HR=1.52; 95% CI, 1.12-2.05 and HR=1.54; 95% CI, 1.14-2.07).
After adjusting for antidiabetic medication, quartiles 1 and 2 remained at higher risk compared with quartile 4.
There were 123 deaths during the first year of follow-up and 180 deaths by 2 years. Of the deaths at 2 years, 62.2% resulted from congestive heart failure, 15.6% were sudden and 22.2% deaths were due to unknown or other causes. At 2 years, 181 patients (21.4%) underwent urgent heart transplantation.
“Further investigations into the mechanisms underlying the relation between HbA1c, [diabetes], and survival in [heart failure] patients are warranted,” the researchers wrote.
Disclosure: Tamara B. Horwich, MD, MS, reported support by a grant 1K23HL 085097 from the National Heart, Lung, and Blood Institute, Bethesda, Md. All other researchers report no relevant financial disclosures.
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