Tuesday, April 17, 2012

Strange but true - Heart failure patients with diabetes are better off not controlling their diabetes

In a retrospective cohort study published in American Journal of Cardiology recently (March 27, 2012), advanced heart failure patients with diabetes had better odds of survival if their HbA1C was greater than or equal to 7.3%, while among the non-diabetics with heart failure, glycemic control did not correlate with survival. Among the patients with diabetes, two-year event-free survival was highest in the two highest quartiles of HbA1C. It may be speculated that low HbA1c levels may reflect an inflammatory state or malnutrition, or some antidiabetic therapies may be causing the adverse cardiac outcomes.

The retrospective analysis involved 845 advanced heart failure patients who were referred for cardiomyopathy center for heart transplant. The cohort of  845 patients,was divided into two subgroups - Diabetics and non-diabetics. In the diabetic cohort following are the findings with regard to 2 year survival. 

Patients with diabetes: Two-year survival free from death/urgent heart transplantation
Quartile HbA1C (%) 2-y survival (%)
1 <6.447.9
2 6.5-7.241.5
3 7.3-8.560.7
4 >8.665.3