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. 2016 May 20:16:99.
doi: 10.1186/s12872-016-0275-6.

Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes

Saul Blecker  1   2 , Hannah Park  3 , Stuart D Katz  4
Affiliations

Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes

Saul Blecker et al. BMC Cardiovasc Disord. .

Abstract

Background: Comorbid diabetes is common in heart failure and associated with increased hospitalization and mortality. Nonetheless, the association between glycemic control and outcomes among patients with heart failure and diabetes remains poorly characterized, particularly among low income and minority patients.

Methods: We performed a retrospective cohort study of outpatients with heart failure and diabetes in the New York City Health and Hospitals Corporation, the largest municipal health care system in the United States. Cox proportional hazard models were used to measure the association between HbA1c levels and outcomes of all-cause hospitalization, heart failure hospitalization, and mortality.

Results: Of 4723 patients with heart failure and diabetes, 42.6 % were black, 30.5 % were Hispanic/Latino, 31.4 % were Medicaid beneficiaries and 22.9 % were uninsured. As compared to patients with an HbA1c of 8.0-8.9 %, patients with an HbA1c of <6.5, 6.5-6.9, 7.0-7.9, and ≥9.0 % had an adjusted hazard ratio (aHR) (95 % CI) for all-cause hospitalization of 1.03 (0.90-1.17), 1.05 (0.91-1.22), 1.03 (0.90-1.17), and 1.13 (1.00-1.28), respectively. An HbA1c ≥ 9.0 % was also associated with an increased risk of heart failure hospitalization (aHR 1.33; 95 % CI 1.11-1.59) and a non-significant increased risk in mortality (aHR 1.20; 95 % CI 0.99-1.45) when compared to HbA1c of 8.0-8.9 %.

Conclusions: Among a cohort of primarily minority and low income patients with heart failure and diabetes, an increased risk of hospitalization was observed only for an HbA1c greater than 9 %.

Keywords: Diabetes; Heart failure; hbA1c.

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Figures

Fig. 1
Fig. 1
Kaplan Meier curves for hospitalization free survival by HbA1c category among 4723 patients with heart failure and diabetes. p = 0.10 for differences among curves using the log-rank test
See this image and copyright information in PMC

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