Heart Failure Patients’ Blood Glucose Levels Predict Mortality Risk

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).

People who arrive at hospital emergency departments with acute heart failure should have their blood sugar levels checked on arrival as this simple and inexpensive measure could identify patients at high risk of early death, further hospitalizations, or the development of more health problems, such as diabetes.

Clinical scientists at the Institute for Clinical Evaluative Sciences (Toronto, ON, Canada) performed a competing risk analysis for 30-day mortality, new diabetes diagnoses, and hospitalization outcomes in a population-based cohort of 16,524 AHFS patients presenting to the emergency department (ED) in Ontario (Canada) between 2004 and 2007. Presentation blood glucose concentrations were categorized as follows: 3.9–6.1 (reference), >6.1–7.8, >7.8–9.4, >9.4–11.1, and >11.1 mmol/L.

The investigators found that patients without preexisting diabetes had a risk of death within 30 days from any cause that was 26% higher than the reference group if their blood glucose levels were between 6.1–7.8 mmol/L, rising to 50% higher if their levels exceeded 11.1 mmol/L. Their risk of death from cardiovascular causes was 28% higher for levels between 6.1–7.8 mmol/L, rising to 64% higher for levels between 9.4–11.1 mmol/L. As their blood glucose levels rose, so did their risk of subsequently developing diabetes; for levels between 6.1–7.8 mmol/L, their risk of diabetes was 61% higher, and this rose by 14% for every 1 mmol/L increase in blood glucose. If their levels exceeded 11.1 mmol/L, their risk of diabetes was 261% higher. Among all patients, with and without preexisting diabetes, blood sugar levels above 9.4 mmol/L increased the risks of hospitalization by 9%–15% for heart failure or cardiovascular causes.

Douglas S. Lee, MD, PhD, an Associate Professor of Medicine, and lead author of the study, said, “Our findings suggest that the measurement of blood sugar levels in all patients arriving at emergency departments with acute heart failure could provide doctors with useful prognostic information and could help to improve outcomes in these patients. It is a rapid, readily available and inexpensive test that could be used to enable doctors to quickly assess a patient’s risk for a wide range of possible outcomes and to suggest appropriate screening strategies that should be put in place.” The study was published on January 7, 2015, in the European Heart Journal.

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