title: Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes.
abstract: BACKGROUND
  Comorbid diabetes is common in heart failure and associated with increased hospitalization and mortality. Nonetheless, the association between glycemic control and outcomes among patients with heart failure and diabetes remains poorly characterized, particularly among low income and minority patients.
  
  
  METHODS
  We performed a retrospective cohort study of outpatients with heart failure and diabetes in the New York City Health and Hospitals Corporation, the largest municipal health care system in the United States. Cox proportional hazard models were used to measure the association between HbA1c levels and outcomes of all-cause hospitalization, heart failure hospitalization, and mortality.
  
  
  RESULTS
  Of 4723 patients with heart failure and diabetes, 42.6 % were black, 30.5 % were Hispanic/Latino, 31.4 % were Medicaid beneficiaries and 22.9 % were uninsured. As compared to patients with an HbA1c of 8.0-8.9 %, patients with an HbA1c of <6.5, 6.5-6.9, 7.0-7.9, and ≥9.0 % had an adjusted hazard ratio (aHR) (95 % CI) for all-cause hospitalization of 1.03 (0.90-1.17), 1.05 (0.91-1.22), 1.03 (0.90-1.17), and 1.13 (1.00-1.28), respectively. An HbA1c ≥ 9.0 % was also associated with an increased risk of heart failure hospitalization (aHR 1.33; 95 % CI 1.11-1.59) and a non-significant increased risk in mortality (aHR 1.20; 95 % CI 0.99-1.45) when compared to HbA1c of 8.0-8.9 %.
  
  
  CONCLUSIONS
  Among a cohort of primarily minority and low income patients with heart failure and diabetes, an increased risk of hospitalization was observed only for an HbA1c greater than 9 %.
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY, USA. saul.blecker@nyumc.org.|Department of Medicine, NYU School of Medicine, New York, NY, USA. saul.blecker@nyumc.org.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Medicine, NYU School of Medicine, New York, NY, USA.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood* / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009519:New York City / Q000453:epidemiology; D011203:Poverty; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Heart failure; hbA1c