title: Differential Effect of Glycosylated Hemoglobin Value and Antidiabetic Treatment on the Risk of 30-day Readmission Following a Hospitalization for Acute Heart Failure.
abstract: OBJECTIVE
  In patients with heart failure and type 2 diabetes, low glycosylated hemoglobin has been related with higher risk of mortality but information regarding morbidity is scarce. We sought to evaluate the association between glycosylated hemoglobin and 30-day readmission in patients with type 2 diabetes and acute heart failure.
  
  
  METHODS
  Glycosylated hemoglobin was measured before discharge in 835 consecutive patients with acute heart failure and type 2 diabetes. Cox regression analysis adapted for competing events was used.
  
  
  RESULTS
  Mean (standard deviation) age was 72.9 (9.6) years and median glycosylated hemoglobin was 7.2% (6.5%-8.0%). Patients treated with insulin or insulin/sulfonylurea/meglitinides were 41.1% and 63.2% of the cohort, respectively. At 30 days post-discharge, 109 (13.1%) patients were readmitted. A multivariate analysis revealed that the effect of glycosylated hemoglobin on the risk of 30-day readmission was differentially affected by the type of treatment (P for interaction<.01). Glycosylated hemoglobin (per 1% decrease) was inversely associated with higher risk in those receiving insulin (hazard ratio = 1.45; 95% confidence interval, 1.13-1.86; P=.003) or insulin/sulfonylurea/meglitinides (hazard ratio = 1.44; 95% confidence interval, 1.16-1.80; P=.001). Conversely, glycosylated hemoglobin (per 1% increase) had no effect in non-insulin dependent diabetes (hazard ratio = 1.01; 95% confidence interval, 0.87-1.17; P=.897) or even a positive effect in patients not receiving insulin/sulfonylurea/meglitinides (hazard ratio = 1.12; 95% confidence interval, 1.03-1.22; P=.011).
  
  
  CONCLUSIONS
  In acute heart failure, glycosylated hemoglobin showed to be inversely associated to higher risk of 30-day readmission in insulin-dependent or those treated with insulin/sulfonylurea/meglitinides. A marginal effect was found in the rest. Whether this association reflects a treatment-related effect or a surrogate of more advanced disease should be clarified in further studies.
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain. Electronic address: yulnunez@gmail.com.
authors: Julio
authors: J
authors: Núñez
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Clara
authors: C
authors: Bonanad
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Juan Paulo
authors: JP
authors: Navarro
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Lourdes
authors: L
authors: Bondanza
authors: Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario, INCLIVA, CIBERDEM and Universitat de Valencia, Valencia, Spain.
authors: Ana
authors: A
authors: Artero
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Silvia
authors: S
authors: Ventura
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Eduardo
authors: E
authors: Núñez
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Gema
authors: G
authors: Miñana
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Juan
authors: J
authors: Sanchis
authors: Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario, INCLIVA, CIBERDEM and Universitat de Valencia, Valencia, Spain.
authors: José
authors: J
authors: Real
mesh_terms: D000208:Acute Disease; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Acute heart failure; Control de la glucemia; Diabetes treatment; Glucohemoglobina; Glycemic control; Glycosylated hemoglobin; Insuficiencia cardiaca aguda; Readmission risk; Riesgo de reingreso; Tratamiento de la diabetes