Heart failure blood sugar levels at ED intake predict risks for death, hospitalization

Patients who arrived at the emergency department with acute heart failure syndromes and mildly elevated blood glucose levels may be at increased risk for death or hospitalization within the first 30 days, according to a study published online Jan. 7 in the European Heart Journal.

Maneesh Sud, MD, from the University Heath Network at the University of Toronto, and colleagues used Ontario population data from 2004 through 2007 for their study.

In acute heart failure patients with diabetes, the 30-day, all-cause mortality risk was 2.48 when blood glucose exceeded 11.1 mmol/L. Nondiabetic patients had increased 30-day all-cause mortality risk when blood glucose was above 6.1 mmol/L; between 6.1 and 7.8 mmol/L, risk for all-cause mortality was 1.26. Thirty-day all-cause mortality risk for nondiabetic, acute heart failure patients was 1.5.

A gradually increased risk for cardiovascular-related death was also linked to blood sugar as it elevated beyond 6.1 mmol/L.

Risk for cardiovascular hospitalizations increased at the upper ends of blood glucose levels for all acute heart failure syndrome patients. When blood glucose was above 9.4 mmol/L, risk was 1.12; when blood glucose was above 11.1 mmol/L, risk was 1.09. Risk for heart failure readmissions were the same above 9.4 mmol/L, at 1.15.

There was a titrated increase for a new diabetes diagnosis among heart failure patients, increasing risk by 1.14 per 1 mmol/L blood glucose elevation. Men had a higher risk per 1 mmol/L increase than women, 1.18 and 1.13, respectively.

Sud et al noted, “Examination of presentation blood glucose may allow for more timely primary and secondary intervention strategies to prevent future diabetes-related hospitalizations and complications.” They went on to write that while professional recommendations currently include diabetes testing for patients presenting with acute MI and hyperglycemia, that acute heart failure should be included when considering patients’ blood sugar levels.

“Blood glucose at presentation may serve as a screen to identify high-risk patients who warrant formal testing for diabetes allowing for prompt referral to prevent further morbidity and mortality,” Sud et al wrote.