Arrhythmias & electrophysiologyCohort study
The association of haemoglobin A1c variability with adverse outcomes in patients with atrial fibrillation prescribed anticoagulants
- Cohort study
Authors' conclusion
Greater HbA1c variability was independently associated with increased risk of IS/SE and all-cause mortality among patients with AF, regardless of diabetic status.
Study context
- Population
- Patients newly diagnosed with non-valvular atrial fibrillation (AF), 2013–2018, prescribed anticoagulants, with ≥3 haemoglobin A1c (HbA1c) measurements
- Participants
- 8,790 patients
- Exposure
- Greater vs lowest HbA1c variability, by diabetes status
- Outcome
- Ischaemic stroke/systemic embolism (IS/SE) and all-cause mortality
- Follow-up
- Median 5.5 years
Main finding
As reported in the abstract
IS/SE and all-cause mortality by HbA1c variability (CV tertile)
Diabetes
3.74 per 100 person-years
Ischaemic stroke (IS)/SE · All-cause mortality 4.89
Non-diabetes
2.41 per 100 person-years
IS/SE · All-cause mortality 2.42 per 100 person-years
Hazard ratio (95% CI)
DiabetesIS/SE; greater HbA1c variability vs lowest CV tertile, adjusted incl. mean HbA1c
1.65(1.27–2.13)
Diabetesall-cause mortality; greater HbA1c variability vs lowest CV tertile, adjusted incl. mean HbA1c
1.24(1.05–1.47)
Non-diabetesIS/SE; similar pattern
1.58(1.23–2.02)
Non-diabetesall-cause mortality; similar pattern
1.35(1.10–1.64)
Observational data: associations, not effects.
Further findings
Incidence rates by diabetes status · median follow-up 5.5 years
- Diabetes: IS/SE (per 100 person-years)
- 3.74
- Diabetes: all-cause mortality (per 100 person-years)
- 4.89
- No diabetes: IS/SE (per 100 person-years)
- 2.41
- No diabetes: all-cause mortality (per 100 person-years)
- 2.42
Original publication
The association of haemoglobin A1c variability with adverse outcomes in patients with atrial fibrillation prescribed anticoagulants. Eur J Prev Cardiol. Published 14 August 2024. doi:10.1093/eurjpc/zwae249
Summarised from the published abstract; every number is checked against it