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Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure

Objective:To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.Design:Cohort study.Setting:Urban University hospital.Patients:All index emergency HF admissions to one University hospital during the year 2000 were studied.Results:454 c... Full description

Journal Title: Heart (British Cardiac Society) 2008-03, Vol.94 (3), p.296-304
Main Author: Berry, C
Other Authors: Brett, M , Stevenson, K , McMurray, J J V , Norrie, J
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: BMJ Publishing Group Ltd and British Cardiovascular Society
ID: ISSN: 1355-6037
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title: Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure
format: Article
creator:
  • Berry, C
  • Brett, M
  • Stevenson, K
  • McMurray, J J V
  • Norrie, J
subjects:
  • Abridged Index Medicus
  • Acute Disease
  • Aged
  • Biological and medical sciences
  • Blood Glucose - metabolism
  • Cardiology. Vascular system
  • Comorbidity
  • Diabetes
  • Diabetes Mellitus - blood
  • Diabetes Mellitus - mortality
  • Diabetes. Impaired glucose tolerance
  • Diabetic Angiopathies - blood
  • Diabetic Angiopathies - complications
  • Diabetic Angiopathies - mortality
  • Drug therapy
  • Echocardiography - methods
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Epidemiologic Methods
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Female
  • Glomerular Filtration Rate - physiology
  • Glucose
  • Glucose intolerance
  • Glucose Intolerance - blood
  • Glucose Intolerance - complications
  • Glucose Intolerance - mortality
  • Heart
  • Heart attacks
  • Heart failure
  • Heart Failure - blood
  • Heart Failure - complications
  • Heart Failure - mortality
  • Heart failure, cardiogenic pulmonary edema, cardiac enlargement
  • Humans
  • Male
  • Medical sciences
  • Mortality
  • Patient outcomes
  • Prognosis
  • Stroke Volume - physiology
  • Systole - physiology
  • Ventricular Dysfunction, Left - diagnostic imaging
ispartof: Heart (British Cardiac Society), 2008-03, Vol.94 (3), p.296-304
description: Objective:To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.Design:Cohort study.Setting:Urban University hospital.Patients:All index emergency HF admissions to one University hospital during the year 2000 were studied.Results:454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1355-6037
fulltext: fulltext
issn:
  • 1355-6037
  • 1468-201X
url: Link


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titleNature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure
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creatorBerry, C ; Brett, M ; Stevenson, K ; McMurray, J J V ; Norrie, J
creatorcontribBerry, C ; Brett, M ; Stevenson, K ; McMurray, J J V ; Norrie, J
descriptionObjective:To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.Design:Cohort study.Setting:Urban University hospital.Patients:All index emergency HF admissions to one University hospital during the year 2000 were studied.Results:454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital. After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632–978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075). Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023.Conclusions:Admission blood glucose concentration and diabetes are prognostically important in HF and could help target some patients for more intensive therapy.
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0ISSN: 1355-6037
1EISSN: 1468-201X
2DOI: 10.1136/hrt.2006.110999
3PMID: 17664189
languageeng
publisherLondon: BMJ Publishing Group Ltd and British Cardiovascular Society
subjectAbridged Index Medicus ; Acute Disease ; Aged ; Biological and medical sciences ; Blood Glucose - metabolism ; Cardiology. Vascular system ; Comorbidity ; Diabetes ; Diabetes Mellitus - blood ; Diabetes Mellitus - mortality ; Diabetes. Impaired glucose tolerance ; Diabetic Angiopathies - blood ; Diabetic Angiopathies - complications ; Diabetic Angiopathies - mortality ; Drug therapy ; Echocardiography - methods ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Epidemiologic Methods ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Glomerular Filtration Rate - physiology ; Glucose ; Glucose intolerance ; Glucose Intolerance - blood ; Glucose Intolerance - complications ; Glucose Intolerance - mortality ; Heart ; Heart attacks ; Heart failure ; Heart Failure - blood ; Heart Failure - complications ; Heart Failure - mortality ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Male ; Medical sciences ; Mortality ; Patient outcomes ; Prognosis ; Stroke Volume - physiology ; Systole - physiology ; Ventricular Dysfunction, Left - diagnostic imaging
ispartofHeart (British Cardiac Society), 2008-03, Vol.94 (3), p.296-304
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3McMurray, J J V
4Norrie, J
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descriptionObjective:To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.Design:Cohort study.Setting:Urban University hospital.Patients:All index emergency HF admissions to one University hospital during the year 2000 were studied.Results:454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital. After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632–978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075). Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023.Conclusions:Admission blood glucose concentration and diabetes are prognostically important in HF and could help target some patients for more intensive therapy.
subject
0Abridged Index Medicus
1Acute Disease
2Aged
3Biological and medical sciences
4Blood Glucose - metabolism
5Cardiology. Vascular system
6Comorbidity
7Diabetes
8Diabetes Mellitus - blood
9Diabetes Mellitus - mortality
10Diabetes. Impaired glucose tolerance
11Diabetic Angiopathies - blood
12Diabetic Angiopathies - complications
13Diabetic Angiopathies - mortality
14Drug therapy
15Echocardiography - methods
16Endocrine pancreas. Apud cells (diseases)
17Endocrinopathies
18Epidemiologic Methods
19Etiopathogenesis. Screening. Investigations. Target tissue resistance
20Female
21Glomerular Filtration Rate - physiology
22Glucose
23Glucose intolerance
24Glucose Intolerance - blood
25Glucose Intolerance - complications
26Glucose Intolerance - mortality
27Heart
28Heart attacks
29Heart failure
30Heart Failure - blood
31Heart Failure - complications
32Heart Failure - mortality
33Heart failure, cardiogenic pulmonary edema, cardiac enlargement
34Humans
35Male
36Medical sciences
37Mortality
38Patient outcomes
39Prognosis
40Stroke Volume - physiology
41Systole - physiology
42Ventricular Dysfunction, Left - diagnostic imaging
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authorBerry, C ; Brett, M ; Stevenson, K ; McMurray, J J V ; Norrie, J
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abstractObjective:To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.Design:Cohort study.Setting:Urban University hospital.Patients:All index emergency HF admissions to one University hospital during the year 2000 were studied.Results:454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital. After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632–978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075). Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023.Conclusions:Admission blood glucose concentration and diabetes are prognostically important in HF and could help target some patients for more intensive therapy.
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pubBMJ Publishing Group Ltd and British Cardiovascular Society
pmid17664189
doi10.1136/hrt.2006.110999