012 Automated data capture from echocardiography reports to enhance heart failure population research

Abstract

Objective To examine the relationship between the mean of all HbA1c measures after CHF diagnosis and outcome in a large cohort of T2DM patients with incident CHF. Design Retrospective, observational cohort study. Setting Tayside, Scotland. Patients T2DM patients with incident CHF between 1993 and 2010. Measurement A weighted mean HbA1c was calculated using all available HbA1c measures following CHF diagnosis and patients were grouped into five categories of HbA1c (#6%, >6e#7%, >7e#8%, >8e#9% and >9%). We subsequently compared diet and drug treated populations. The relationship between mean HbA1c and all-cause deaths after CHF diagnosis was assessed. Results 795 patients with T2DM met study criteria. Median followup of 3.8 years saw 491 (61.8%) deaths. Cox regression model, adjusted for all other significant predictors, with the middle HbA1c category (>7e#8%) as the reference, showed a U shaped relationship between HbA1c and outcome. (<6% [HR 95% CI 1.78 (1.26 to 2.52)]; >6e#7% [1.29 (1.01 to 1.66)] and >9% [1.38 (1.03 to 1.84)]. We found a similar relationship in the drug treated subgroup. However in the diet only group, low HbA1c was associated with the lowest risk of death (#7% [0.17 (0.07 to 0.39)]). Conclusions In patients with T2DM and CHF, our observational study shows that in drug treated patients there was a U shaped relationship between HbA1c and mortality with the lowest mortality risk in patients with modest glycaemic control (HbA1c, >7e#9%). However in diet treated patients, lower HbA1c was associated with lower mortality risk.

Both High and Low HbA1c Predict Incident Heart Failure in Type 2 Diabetes Mellitus

“…All individuals with T2DM and a hospital admission with HF according to ICD codes (ICD 9: 428, ICD10: I50) or an echocardiogram with evidence of LVSD and a prescription for a loop-diuretic (BNF code 2.2.2) were regarded as HF cases. A previous case validation exercise found 91% concordance between a clinical diagnosis of HF from case note review and definition of HF based on an echocardiographic evidence of LVSD requiring prescription of loop diuretics (23, 27-28). Only incident HF cases were included in the analysis.…”