Impact of glycated hemoglobin on 2-year clinical outcomes in elderly patients with atrial fibrillation: sub-analysis of ANAFIE Registry, a large observational study
Authors' conclusion
Among elderly Japanese patients with NVAF, only HbA1c ≥ 8.0% was associated with increased all-cause death and net clinical outcome risks; risks of the events did not increase in other HbA1c subgroups. Relative event risks between patients treated with DOACs and warfarin were not modified by HbA1c level.
Study context
- Population
- Japanese patients aged ≥75 years with non-valvular AF, with and without clinical diagnosis of DM, with baseline HbA1c datawith baseline HbA1c
- Participants
- 17,526 patients
- Comparison
- HbA1c categories
- HbA1c < 6.0%n = 8,725reference
- HbA1c 6.0% to < 7.0%n = 6,700
- HbA1c 7.0% to < 8.0%n = 1,548
- HbA1c ≥ 8.0%n = 553
- Primary endpoint
- Main endpoints: stroke/SEE, major bleeding, intracranial hemorrhage, cardiovascular death, all-cause death and net clinical outcome (composite of stroke/SEE, major bleeding and all-cause death)
- Follow-up
- 2 years
Methodological detailsmulticenter, subgroup analysis by HbA1c
- Multicenter
- Subgroup analysis by HbA1c
Primary result
As reported in the abstract
HbA1c ≥ 8.0% vs HbA1c < 6.0%Adjusted hazard ratio (95% CI)
All-cause death; multivariate analysis
1.46(1.11–1.93)
Net clinical outcome; multivariate analysis
1.33(1.05–1.68)
- HbA1c ≥ 8.0% subgroup had higher event rates for all-cause death
- log-rank P = 0.003
- HbA1c ≥ 8.0% subgroup had higher event rates for net clinical outcome
- log-rank P = 0.007
Further findings
Interaction between HbA1c and OACs
- No interaction observed between HbA1c and OACs
Antidiabetic drugs
- Use/non-use of antidiabetic drugs not associated with risk reduction; event risks did not differ with/without injectable antidiabetic drugs
Safety
- No significant differences in risk of major bleeding across HbA1c subgroups
Original publication
Impact of glycated hemoglobin on 2-year clinical outcomes in elderly patients with atrial fibrillation: sub-analysis of ANAFIE Registry, a large observational study. Cardiovasc Diabetol. Published 12 July 2023. doi:10.
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