European Heart Journal Advance Access published January 8, 2015 CLINICAL RESEARCH European Heart Journal doi:10.1093/eurheartj/ehu462 Heart failure/cardiomyopathy Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes Maneesh Sud, Xuesong Wang, Peter C. Austin, Lorraine L. Lipscombe, Gary E. Newton, Jack V. Tu, Ramachandran S. Vasan, and Douglas S. Lee * Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network University of Toronto, Toronto, ON, Canada Received 9 February 2014; revised 4 November 2014; accepted 6 November 2014 Purpose The prognostic implications of blood glucose on a wide range of outcomes including early mortality, hospitalizations, and incident diabetes diagnoses have not been fully elucidated in acute heart failure syndromes (AHFS). ..................................................................................................................................................................................... Methods In a population-based cohort of16 524 AHFS patients presenting to the emergencydepartment (ED) in Ontario, Canada between 2004 and 2007, we performed a competing risk analysis for 30-day mortality, new diabetes diagnoses, and hos- pitalization outcomes. Presentation blood glucose concentrations were categorized as follows: 3.9–6.1 [referent], . 6.1–7.8, . 7.8–9.4, . 9.4–11.1, and . 11.1 mmol/L. ..................................................................................................................................................................................... Results AmongAHFSpatientswithoutdiabetespresentingtotheED( n ¼ 9275),bloodglucose . 6.1 mmol/L( n ¼ 5252,56.6%) was associated with increased risks of all-cause death [hazard ratio (HR) range: 1.26 (95% CI 1.05–1.50) to 1.50 (95% CI 1.11–2.02)], and cardiovascular death [HR range: 1.28 (95% CI 1.03–1.59) to 1.64 (95% CI 1.16–2.33)]. Among AHFS patients with diabetes ( n ¼ 7249), presenting blood glucose . 11.1 mmol/L ( n ¼ 2286, 31.5%) was associated with increased risks of all-cause death (HR 1.48, 95% CI 1.10–2.00) and diabetes-related hospitalizations (HR 1.39, 95% CI; 1.20–1.61). Presentation blood glucose . 9.4 mmol/L was associated with increased risks of hospitalization for HF or cardiovascular causes [HR range: 1.09 (95% CI 1.02–1.17) to 1.15 (95% CI 1.07–1.24)] in all patients. With higher pres- entationbloodglucose,theriskofincidentdiabetesdiagnosisincreased,withadjustedHRsof1.61( . 6.1–7.8 mmol/L)to 3.61 ( . 11.1 mmol/L) among those without the condition at baseline (all P , 0.001). ..................................................................................................................................................................................... Conclusions Mildly elevated presentation blood glucose was associated with early death, future diabetes, and hospitalizations for diabetes, HF, and cardiovascular causes among patients with AHFS. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Keywords Heart failure † Mortality † Morbidity † Hospitalization † Diabetes † Complications † Prognosis † Outcomes † Blood glucose which can occur in up to 40% of patients irrespective of pre-existing Introduction diabetes status. 3,4 Acute heart failure syndromes (AHFS) account for a substantial In patients hospitalized for acute myocardial infarction (AMI), numberof emergency department (ED) visits annually 1 and are asso- hyperglycaemia is a marker for short-term mortality. 5 The detrimen- ciated with high short- and long-term mortality rates. 2 At the time of tal effects of hyperglycaemia on the ischaemic myocardium act via a presentation, patients with AHFS may demonstrate a wide spectrum shift towards anaerobic myocardial metabolism through enhanced free-fatty acid utilization and impaired glucose utilization, 6 increased ofphysiological and metabolic perturbationssuchashyperglycaemia, * Corresponding author: Tel: ( + 1) 416 340 3861; fax:( + 1) 416 340 3036, Email: dlee@ices.on.ca & The Author 201 . Published by Oxford University Press on behalf of the European Society of Cardiology. 5 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
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