Glycemic Status At Admission Predicts Outcome in Heart Failure Patients

In patients admitted to the hospital with acute heart failure, abnormal glucose tolerance and diabetes are associated with an increased risk of death in the hospital and in the longer term, research indicates.

"Admission blood glucose concentration and diabetes are prognostically important in heart failure and could help target some patients for more intensive therapy," write Dr. John J. V. McMurray from University of Glasgow, UK, and colleagues in the March issue of the journal Heart.

Among 454 consecutive unselected patients admitted to one university hospital for heart failure, 110 (24%) had diabetes, 60 (13%) had abnormal glucose tolerance (8.0-10.99 mmol/L), and 284 (63%) had normal blood glucose on admission (< 8 mmol/L).

Fifty-one patients (11.2%) died in the hospital, and according to the investigators there was a "striking relationship between random blood glucose concentration on admission and total mortality," even after extensive adjustment for other predictors of mortality.

"In-hospital mortality and mortality, and morbidity in the longer term, were higher in patients with abnormal glucose tolerance or diabetes," they report. "Even mild elevations in blood glucose predicted mortality."

The adjusted hazard ratios for death were 1.41 and 2.02, respectively, in patients with abnormal glucose tolerance and diabetes on admission, relative to those with normal admission blood glucose.

"Heart failure patients with abnormal glucose tolerance should receive intensive medical management in order to improve prognosis," Dr. McMurray and colleagues conclude.

Heart 2008;94:296-304.

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FACT:
Posting Surgeon Email Addresses Improves Communication: When patients scheduled for elective surgery can email their surgeons with questions or concerns, levels of communication improve with no apparent detrimental effect on satisfaction with outcome, the New York Times reports. In a prospective study from the University of Sydney, Australia, 100 consecutive patients seen before thyroid or parathyroid surgery were randomly assigned to receive either an information sheet promoting email as the preferred method of communication or a standard information sheet. The primary endpoints were use of communication with the surgeon outside of the booked preoperative and postoperative consultation and results of a satisfaction questionnaire. In all, 38% of patients who were given the surgeon’s email contacted the surgeon perioperatively, compared with 14% of patients given the standard information sheet. There were no differences in patient satisfaction with the level of communication. "While some caution should accompany the use of any such form of communication, this study confirms that the appropriate use of e-mail can significantly enhance surgeon-patient interaction in the perioperative setting," the authors write. Archives of Surgery, February 2008