Abstract 4146739: HBA1C Level Affects Stroke Outcome in AF Patients

Background: The CHA2DS2-VASc score quantifies stroke risk for atrial fibrillation (AF patients), but considers one point for diabetic patients, regardless of glycemic control. Objective: We aim to study the impact of the level of HBA1C on the stroke risk in AF patients. Methods: Utilizing data from the Research Action for Health Network (REACHnet) database, we studied patients within the Tulane University health system from 2010 to 2019. We only included patients diagnosed with AF with at least one HbA1c measurement. For each patient, the average HbA1c was used if there were multiple HbA1c measurements. Patients were categorized to 2 groups; group 1 is patients with HbA1c ≥7% but <9%, while group 2 is Hba1c level more than ≥9%, which is severe hyperglycemia. Patients were followed up for 5 years from the diagnosis of AF. Cox regression was used to investigate the correlation between HBA1C level and ischemic strokes, with potential confounders corrected using the model. Results: We included 1120 patients, there was no significant difference in age (65± 10 vs 64 ± 11, p= 0.308), gender (39.1% vs 33% females, p= 0.287), BMI (30.85 ±8.9 vs 30.74 ±7.9, p=0.672) or race (35.6% vs 36.0% African Americans, p=1.000) between the 2 groups. Group 1 included 87 (7.8%) patients, while group 2 included 1033 (92.2%) with severe hyperglycemia. There was no significant difference between anticoagulants between the 2 groups (74.7% vs 71.4%, p=0.620). Our analysis showed that patients with severe hyperglycemia are at a significantly higher stroke risk compared to those with lower levels (p = 0.027, [HR] = 2.146, CI= [1.09-4.224]), correcting for age, sex, race, CHA2DS2-VASc score, anticoagulants, CAD, hyperlipidemia, and CKD. (Table.1) Conclusion: The analysis showed that severe hyperglycemia doubles the risk of stroke among AF patients. The findings of our study suggest that the severity of hyperglycemia may be more important than the binary status of diabetes. This study further underscores the importance of glycemic control of HBA1C in reducing thromboembolic events.