Objective:
Abnormalities in glucose metabolism may worsen the prognosis of patients hospitalized with an acute coronary syndrome (ACS). We examined the association of in-hospital serum glucose and glycated hemoglobin (HbA1c) levels with the occurrence of 30-day hospital readmissions among adults discharged from the hospital after an ACS.
Methods:
Using data from the Transitions, Risks, and Action in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE) study, we reviewed the medical records of 2,187 patients discharged from 6 hospitals in MA and GA after an ACS between 2011 and 2013. We stratified patients according to diabetes mellitus (DM) status at baseline, as defined by medical history of DM, admission medications, or a serum HbA1c > 6.5%. Using logistic regression models, we calculated crude and adjusted odds ratios to estimate the association between serum HbA1c and glucose levels during hospitalization with 30-day all-cause readmissions. We controlled for prior and inpatient insulin use, age, body mass index, ACS classification, length of stay, and hospital site.
Results:
Data on serum HbA1c and glucose levels were available for 1,102 (50%) participants. This study sample had a mean age of 60 (SD: 11) years, 68% were male, 77% were non-Hispanic white, and 52% had DM. The mean in-hospital serum HbA1c and maximum and minimum serum glucose levels were 8.2%, 277 mg/dL, and 101 mg/dL, respectively, for those with known DM (n = 526) and 5.7%, 155 mg/dL, and 92 mg/dL for those without known DM (n = 576). A higher, but non-significant, proportion of patients with DM (14%) were readmitted to an area medical center within 30 days of discharge compared to those without DM (11%, p = 0.27). Neither serum HbA1c levels, nor minimum or maximum glucose values during hospitalization were associated with all-cause 30-day readmissions among those with and without DM (Table).
Conclusions:
In this prospective study of adults with an ACS, we found no significant association between serum HbA1c or glucose levels with the occurrence of 30-day hospital readmissions. The low proportion of subjects with serum HbA1c testing may have biased the study results. Further investigation should examine the in-hospital management of ACS patients with varying serum glucose and HBA1C levels and their post-discharge outcomes.
Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study
