CHF and HbA1C
According to a study published in The American Journal of Cardiology, diabetic patients with heart failure who had lower levels of glycosylated hemoglobin were more likely to die or need urgent heart transplantation during two years of follow-up compared with those with higher HbA1c levels. Yes, y0u read that right. Who knows, maybe the study is flawed but one professor of cardiology said in the American Medical News that, “We may find that doctors who treat patients who have advanced heart failure and diabetes may not need to focus on aggressively lowering blood [glucose], but rather keep it under moderate control”. So, once again, what about the quality indicators? Sure the patient may die but at least their HbA1C is down. Am I right?
Doctors have to deal with patients, none of which are standard. To that end we have guidelines to, well, guide us. Therein is the permanent trap in the system: a monkey can follow rules but with guidelines the practitioner can always be judged in the wrong depending on which way the winds are blowing.
The government and lawyers will always encourage our following guidelines, to keep their profiting from their self-replenishing resource.
imagine that, just like ACCORD said…and to think that had ACCORD been positive i would have an endocrinologist in my office right now telling me what a f*&^up and an a$$%^&* i am for not having everyone’s A1c’s <6, but since it was negative, we ignore it…