Glycemic status and risks of thromboembolism and major bleeding in patients with atrial fibrillation

Chan, Yi‐Hsin; Chuang, Chi Cheng; Chan, Cze-Ci; Lee, Hsin-Fu; Huang, Yun‐Ching; Huang, Yu‐Tung; Chang, Shang‐Hung; Wang, Chunli; Chao, Tze‐Fan; Kuo, Chi‐Tai; Yeh, Yung‐Hsin; Chen, Shih‐Ann

doi:10.1186/s12933-020-01005-8

Cited by 21 publications

(14 citation statements)

References 41 publications

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“…However, the glycemic status of these patients seems to be the parameter determining their risk of stroke [30], especially when DM lasts less than 10 years [31]. According to Chan et al risk of stroke is significantly increased once HbA1c levels exceeded 6.5% in both diabetic and non-diabetic population with AF [32]. This correlation was not mirrored in our analysis, since higher HbA1c levels did not constitute an independent parameter for higher stroke incidence during the follow-up.…”

Section: Discussioncontrasting

confidence: 66%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

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Background There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan–Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11–1.75), CV mortality (aHR = 1.39, 95% CI 1.07–1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19–2.52), stroke (aHR = 1.87, 95% CI 1.01–3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06–1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6–8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

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Section: Discussioncontrasting

confidence: 66%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

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“…However, the glycemic status of these patients seems to be the parameter determining their risk of stroke 25 , especially when DM lasts less than 10 years 26 . According to Chan et al risk of stroke is signi cantly increased once HbA1c levels exceeded 6.5% in both diabetic and non-diabetic population with AF 27 . This correlation was not mirrored in our analysis, since higher HbA1c levels did not constitute an independent parameter for higher stroke incidence during the follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

et al. 2021

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Funding Acknowledgements Type of funding sources: None. Background Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF. Purpose The purpose of this study was to investigate the association of DM and levels of glycated hemoglobin (HbA1c) with outcomes in patients with AF. Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality, stroke and the composite outcome of CV death or hospitalization. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.44, 95% confidence intervals [CI]: 1.12-1.85), CV mortality (aHR = 1.44, 95% CI: 1.08-1.93), stroke (aHR = 2.62, 95% CI: 1.24-5.53) and the composite outcome of hospitalization or CV death (aHR = 1.28, 95% CI: 1.06-1.54). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values <6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with a 1.5-fold increased risk for all-cause or CV mortality and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates. Follow-up outcomes by presence of DMOutcomeDMNon-DMAdjusted HR(95% CI)p-valueAll-cause death171/373 (45.8%)243/736 (33%)1.44 (1.12-1.85)<0.001CV-death130/373 (34.9%)173/736 (23.5%)1.44 (1.08-1.93)<0.001Major bleeding18/340 (5.3%)29/644 (4.5%)1.53 (0.71-3.28)0.291Stroke24/340 (7.1%)28/645 (4.3%)2.62 (1.24-5.53)0.013AF-related hospitalization59/340 (17.4%)115/645 (17.8%)1.20 (0.78-1.85)0.281HF-related hospitalization35/333 (10.5%)46/640 (7.2%)1.34 (0.83-2.19)0.235Hospitalization or CV-death243/373 (65.1%)399/736(54.2%)1.28 (1.06-1.54)<0.001*Adjusted for: age, gender, smoking, BMI, history of hypertension, eGFR (CKD-EPI) and use of statin, ACEI-ARB, OAC and rate control medication after discharge.DM, diabetes mellitus; HR, hazard ratio; AF, atrial fibrillation; CV, cardiovascular; HF, heart failure.Abstract Figure. Visual overview of the study

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“…However, the glycemic status of these patients seems to be the parameter determining their risk of stroke 30 , especially when DM lasts less than 10 years 31 . According to Chan et al risk of stroke is signi cantly increased once HbA1c levels exceeded 6.5% in both diabetic and non-diabetic population with AF 32 . This correlation was not mirrored in our analysis, since higher HbA1c levels did not constitute an independent parameter for higher stroke incidence during the follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Σαμαράς

et al. 2021

Preprint

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Background: There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF).Methods: This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.Results: In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR=1.40 95% confidence intervals [CI]: 1.11-1.75), CV mortality (aHR=1.39, 95% CI: 1.07-1.81), sudden cardiac death (aHR=1.73, 95% CI: 1.19-2.52), stroke (aHR=1.87, 95% CI: 1.01-3.45) and the composite outcome of hospitalization or CV death (aHR=1.27, 95% CI: 1.06-1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6-8.2% being independent predictors of increased all-cause mortality, and values <6.2% predicting significantly decreased all-cause and CV mortality.Conclusions: The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

show abstract

Glycemic status and risks of thromboembolism and major bleeding in patients with atrial fibrillation

Cited by 21 publications

References 41 publications

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

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