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Glycosylated haemoglobin assessment in diabetic patients with acute coronary syndromes
Author(s) -
Snir A.,
Dabin B.,
Hyun K.,
Yamen E.,
Ryan M.,
AliprandiCosta B.,
Brieger D.
Publication year - 2016
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13038
Subject(s) - medicine , acute coronary syndrome , hazard ratio , emergency medicine , diabetes mellitus , myocardial infarction , cohort , risk assessment , logistic regression , cardiac catheterisation , confidence interval , intensive care medicine , cardiology , computer security , computer science , endocrinology
Background Guidelines for the management of acute coronary syndromes ( ACS ) advocate for maintaining adequate long‐term glycaemic control in diabetic patients. Glycosylated haemoglobin ( HbA1c ) measurement is commonly used to monitor long‐term glycaemic control in diabetes. Aims To evaluate the frequency and clinical predictors of in‐hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge. Methods This registry‐based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS . Independent predictors of HbA1c assessment were evaluated using a multivariable logistic generalised estimating equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis. Results Seven hundred and fourteen (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7–87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, ST‐Elevation Myocardial Infarction, cardiac catheterisation and coronary artery bypass surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence‐based medicines but not with mortality during 6 months following discharge (hazard ratio, 0.48; 95% confidence interval, 0.19–1.18). Conclusion Frequency of HbA1c assessment varies markedly between hospitals, and most diabetic patients admitted for ACS in Australia do not receive assessment of pre‐admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care.