title: Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus.
abstract: BACKGROUND
  Glycated haemoglobin (HbA1c) is an indicator of average blood glucose concentrations over the preceding 3 months, is simpler to perform than either a fasting glucose or glucose tolerance test and is associated with a worse prognosis in some clinical settings. However, its relationship to survival in patients with suspected heart failure has not been studied.
  
  
  METHODS
  Patients referred to a community-based heart failure clinic with suspected heart failure had a comprehensive assessment including the measurement of HbA1c. For this analysis, patients with DM or who started diabetic medication in the subsequent 12 months, which might influence HbA1c, were excluded.
  
  
  RESULTS
  Of 970 non-diabetic patients referred between 2001 and 2004, the median age was 72 years (range 25 to 96 years), 56% were men, 45% had left ventricular ejection fraction (LVEF) <or=45%, and 50% had an HbA1c >6% (upper reference limit). Among patients with LVEF <or=45%, there was an abrupt increase in mortality in those with an HbA1c >6.7% (n = 68) compared with those with HbA1c <or=6.7% (n = 368) (hazard ratio (HR): 2.4, p<0.001), and this persisted after adjustment for age and comorbidity (HR 1.9, p = 0.008); respective 1-year mortalities were 26.5% and 9.4%. This increase in mortality was not seen in those with LVEF >45% (HR 1.44, p = 0.36 after adjustment).
  
  
  CONCLUSIONS
  The abrupt increase in mortality with HbA1c may make it a useful risk stratification tool in non-diabetic patients with LVEF <or=45% which could help improve clinical management.
authors.affiliation: Department of Cardiology, Division of Cardiovascular & Respiratory Studies, Postgraduate Medical Institute, Castle Hill Hospital, Kingston-upon-Hull, UK. kevin.goode@hey.nhs.uk
authors.forename: K M
authors.initials: KM
authors.lastname: Goode
authors.forename: J
authors.initials: J
authors.lastname: John
authors.forename: A S
authors.initials: AS
authors.lastname: Rigby
authors.forename: E S
authors.initials: ES
authors.lastname: Kilpatrick
authors.forename: S L
authors.initials: SL
authors.lastname: Atkin
authors.forename: T
authors.initials: T
authors.lastname: Bragadeesh
authors.forename: A L
authors.initials: AL
authors.lastname: Clark
authors.forename: J G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000401:mortality*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin