title: Glycosylated haemoglobin assessment in diabetic patients with acute coronary syndromes.
abstract: BACKGROUND
  Guidelines for the management of acute coronary syndromes (ACS) advocate for maintaining adequate long-term glycaemic control in diabetic patients. Glycosylated haemoglobin (HbA1c) measurement is commonly used to monitor long-term glycaemic control in diabetes.
  
  
  OBJECTIVE
  To evaluate the frequency and clinical predictors of in-hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge.
  
  
  METHODS
  This registry-based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS. Independent predictors of HbA1c assessment were evaluated using a multivariable logistic generalised estimating equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis.
  
  
  RESULTS
  Seven hundred and fourteen (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7-87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, ST-Elevation Myocardial Infarction, cardiac catheterisation and coronary artery bypass surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence-based medicines but not with mortality during 6 months following discharge (hazard ratio, 0.48; 95% confidence interval, 0.19-1.18).
  
  
  CONCLUSIONS
  Frequency of HbA1c assessment varies markedly between hospitals, and most diabetic patients admitted for ACS in Australia do not receive assessment of pre-admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care.
authors: Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors: A
authors: A
authors: Snir
authors: Concord Hospital, Sydney, New South Wales, Australia.
authors: B
authors: B
authors: Dabin
authors: Concord Hospital, Sydney, New South Wales, Australia.
authors: K
authors: K
authors: Hyun
authors: Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: E
authors: E
authors: Yamen
authors: Shoalhaven Hospital, Shoalhaven, New South Wales, Australia.
authors: M
authors: M
authors: Ryan
authors: Faculty of Nursing, University of Sydney, Sydney, New South Wales, Australia.
authors: B
authors: B
authors: Aliprandi-Costa
authors: Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors: D
authors: D
authors: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D001315:Australia; D001786:Blood Glucose; D006328:Cardiac Catheterization; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D048909:Diabetes Complications / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: acute coronary syndrome; delivery of health care; diabetes mellitus; haemoglobin A, glycosylated