Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences; Department of Emergency Medicine; Meyers Primary Care Institute
Jane S. Saczynski
Medical Subject Headings
Hyperglycemia; Heart Failure; Diabetes Mellitus; Hospitalization
Cardiovascular Diseases | Endocrine System Diseases | Health Services Research | Life Sciences | Medicine and Health Sciences
Background: Heart Failure (HF) in the setting of comorbid diabetes mellitus (DM) has been extensively examined and is associated with increased mortality. More recently, hyperglycemia independent of DM status during critical illness admissions has become recognized as an indicator of poor outcomes. Despite evolving understanding of DM in the setting of acute HF, hyperglycemia at time of admission for acute HF has not been examined with regard to in-hospital treatment and patient outcomes.
Objective: The goal of this study is to examine differences in in-hospital treatment and outcomes of patients hospitalized for acute HF according to glycemic status.
Methods: The sample consisted of 9,748 residents of the Worcester (MA) metropolitan area hospitalized at all 11 greater Worcester medical centers for acute decompensated HF during the years 1995 - 2004 with data available on diabetic status and admission glucose measurements. Patients were stratified into three groups based on history of DM and admission hyperglycemia defined by glucose ≥200 mg/dL: 1) nondiabetic, normoglycemic (NDNG); 2) non-diabetic, hyperglycemic (NDHG); and 3) diabetic (DM).
Results: Non-diabetic, normoglycemic patients were similar to NDHG patients with respect to age and medical history and were significantly older and less likely to have a history of various comorbid conditions such as hypertension, stroke and renal disease when compared to diabetics (p-values
Conclusions: The results of our population-based investigation suggest that non-diabetic patients hospitalized for acute HF who are hyperglycemic at the time of admission represent a vulnerable group of patients at risk for increased mortality during hospitalization. Hyperglycemia ≥200 mg/dL during acute HF hospitalization should be taken into account when providing in-hospital management for HF with additional consideration given to ascertainment of diabetic status and glycemic control.
Maselli, Nicholas J.; Darling, Chad E.; McManus, David D.; Lessard, Darleen M.; Goldberg, Robert J.; and Saczynski, Jane S., "Admission Hyperglycemia in Setting of Acute Heart Failure is Associated with Increased In-hospital Mortality Among Patients without Diabetes" (2012). University of Massachusetts Medical School. Senior Scholars Program. Paper 124.