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Heart and Vessels

, Volume 33, Issue 9, pp 1022–1028 | Cite as

Effects of glycemic control on in-hospital mortality among acute heart failure patients with reduced, mid-range, and preserved ejection fraction

  • Kenichi Matsushita
  • Kazumasa Harada
  • Tetsuro Miyazaki
  • Takamichi Miyamoto
  • Kiyoshi Iida
  • Shuzou Tanimoto
  • Mayuko Yagawa
  • Makoto Takei
  • Yuji Nagatomo
  • Toru Hosoda
  • Hideaki Yoshino
  • Takeshi Yamamoto
  • Ken Nagao
  • Morimasa Takayama
Original Article
  • 146 Downloads

Abstract

The relationship between glycemic control and outcome in patients with heart failure (HF) remains contentious. A recent study showed that patients with HF with mid-range ejection fraction (HFmrEF) more frequently had comorbid diabetes relative to other patients. Herein, we examined the association between glycosylated hemoglobin (HbA1c) and in-hospital mortality in acute HF patients with reduced, mid-range, and preserved EF. A multicenter retrospective study was conducted on 5205 consecutive patients with acute HF. Potential risk factors for in-hospital mortality were selected by univariate analyses; then, multivariate Cox regression analysis with backward stepwise selection was performed to identify significant factors. Kaplan–Meier survival curves and log-rank testing were used to compare in-hospital mortality between groups. Across the study cohort, 44% (2288 patients) had reduced EF, 20% had mid-range EF, and 36% had preserved EF. The overall in-hospital mortality rate was 4.6%, with no significant differences among the HF patients with reduced, mid-range, and preserved EF groups. For patients with HFmrEF, higher HbA1c level was a significant risk factor for in-hospital mortality (hazard ratio 1.387; 95% confidence interval 1.014–1.899; P = 0.041). In contrast, HbA1c was not an independent risk factor for in-hospital mortality in HF patients with preserved or reduced EF. In conclusion, HbA1c is an independent risk factor for in-hospital mortality in acute HF patients with mid-range EF, but not in those with preserved or reduced EF. Elucidation of the pathophysiological mechanisms behind these findings could facilitate the development of more effective individualized therapies for acute HF.

Keywords

Ejection fraction Glycemia Glycosylated hemoglobin Heart failure Mortality 

Notes

Acknowledgements

The authors appreciate the help of all members of the Tokyo CCU Network Scientific Committee and Ms. Nobuko Yoshida (Tokyo CCU Network office) for data collection.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

380_2018_1152_MOESM1_ESM.pdf (22 kb)
Supplementary material 1 (PDF 23 kb)
380_2018_1152_MOESM2_ESM.pdf (251 kb)
Supplementary material 2 (PDF 252 kb)

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Kenichi Matsushita
    • 1
    • 2
  • Kazumasa Harada
    • 1
  • Tetsuro Miyazaki
    • 1
  • Takamichi Miyamoto
    • 1
  • Kiyoshi Iida
    • 1
  • Shuzou Tanimoto
    • 1
  • Mayuko Yagawa
    • 1
  • Makoto Takei
    • 1
  • Yuji Nagatomo
    • 1
  • Toru Hosoda
    • 1
  • Hideaki Yoshino
    • 1
    • 2
  • Takeshi Yamamoto
    • 1
  • Ken Nagao
    • 1
  • Morimasa Takayama
    • 1
  1. 1.Tokyo CCU Network Scientific CommitteeTokyoJapan
  2. 2.Division of Cardiology, Second Department of Internal MedicineKyorin University School of MedicineTokyoJapan

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