Patients with advanced heart failure who were also diabetic had better two-year survival if their baseline glycated hemoglobin (HbA1c) levels were >7.3% in a new study. Among the nondiabetic patients with heart failure, HbA1C levels did not predict survival outcomes. The retrospective cohort study is published online March 27, 2012 in the American Journal of Cardiology.

The implications for clinical practice are that in someone with advanced heart failure who may be having difficulties with hypoglycemia or other adverse effects of diabetic medications, less stringent glycemic control (HbA1C <8%) may be acceptable. On the other hand, if patients are tolerating the medications without difficulties, current glycemic guidelines should continue to be followed as we await further information from prospective clinical trials.

Low HbA1c levels may reflect an inflammatory state or malnutrition, or some antidiabetic therapies may be causing the adverse cardiac outcomes, Horwich speculated.

Many, large-scale, phase 3 trials are currently testing the safety and efficacy of diabetic therapies in high-risk patients, including those with heart failure—a group that has often been excluded from glycemia clinical trials.

Hopefully, more prospective data on the best treatment strategies in this patient population over the next several years will be published and for now, practicing clinicians should follow published guidelines, which state that target glycemic goals should be individualized.

Link:
http://www.theheart.org/article/1384869.do