Impact of diabetes and on-arrival hyperglycemia on short-term outcomes in acute heart failure patients.
Por:
Masip J, Povar-Echeverría M, Peacock WF, Jacob J, Gil V, Herrero P, Llorens P, Alquézar-Arbé A, Sánchez C, Martín-Sánchez FJ, Miró Ò and Researchers of the ICA-SEMES and EAHFE Registry
Publicada:
1 ago 2022
Ahead of Print:
29 mar 2022
Resumen:
The impact of diabetes mellitus (DM) and hyperglycemia on short-term prognosis in patients with acute heart failure (AHF) remains controversial as most data comes from series of hospitalized patients. Our purpose was to analyze outcomes in a nation-wide registry of AHF patients attended in emergency department (ED). ED AHF patients were prospectively enrolled, with the index event and the vulnerable post-discharge phase outcomes recorded. The influence of presenting hyperglycemia (> 180 mg/dL) and DM treatment on prognosis were also investigated. All results were adjusted (a) for baseline characteristics. Of 9192 enrolled AHF patients, 4544 (49,4%) were diabetic, with 24% of diabetics and 25.1% of non-diabetic (p = 0.247) directly discharged from the ED also included. Diabetics had higher rates of comorbidities, but were slightly younger and had lower in-hospital and 30 day all-cause mortality than non-diabetics (a-OR = 0.827, 95% CI = 0.690-0980; and a-HR = 0.850, 95% CI = 0.814-1.071, respectively). Conversely, hyperglycemia on-arrival was associated with increased in-hospital, and 30 day all-cause mortality, in both DM (a-OR = 1.933, 95% CI = 1.378-2.712, and a-HR = 1.590, 95% CI = 1.304-1.938, respectively) and non-DM patients (a-OR = 1.498, 95% CI = 1.175-1.909, and a-HR = 1.719, 95% CI = 1.306-2.264, respectively). However, during the vulnerable phase, diabetics had worse short-term outcomes, with higher rates of ED-revisit and rehospitalization. These worse outcomes seemed to be unrelated to the severity of DM. In patients with AHF attended in ED, diabetes was associated with lower index event case fatality, but higher rates of rehospitalization and re-consultation in the vulnerable post-discharge period. Conversely, hyperglycemia at hospital arrival was strongly associated with early mortality, regardless of diabetes status.
Filiaciones:
Masip J:
Research Department, Consorci Sanitari Integral, University of Barcelona, Av. Josep Molins, 29, L'Hospitalet de Llobegat, 08096, Barcelona, Catalonia, Spain.
Povar-Echeverría M:
Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
Peacock WF:
Emergency Department, Baylor Medical School, Houston, Texas, USA
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat Universitat de Barcelona, Barcelona, Catalonia, Spain
Gil V:
Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain
Herrero P:
Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
:
Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
Alquézar-Arbé A:
Emergency Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Catalonia, Spain
Sánchez C:
Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
Miró Ò:
Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain
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