Prakash Deedwania1, Tushar Acharya2, Kamal Kotak2, Gregg C Fonarow3, Christopher P Cannon4, Warren K Laskey5, W Frank Peacock6, Wenqin Pan7, Deepak L Bhatt4. 1. Division of Cardiology, University of California, San Francisco, Fresno, California. Electronic address: pdeedwania@fresno.ucsf.edu. 2. Division of Cardiology, University of California, San Francisco, Fresno, California. 3. Division of Cardiology, University of California, Los Angeles and Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California. 4. Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA. 5. Division of Cardiology, University of New Mexico, Albuquerque, New Mexico. 6. Department of Emergency Medicine, Baylor Medical Center, Houston, TX. 7. Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Abstract
BACKGROUND: To evaluate and compare baseline characteristics, outcomes and compliance with guideline based therapy at discharge among diabetic and non-diabetic patients admitted with acute coronary syndromes (ACS). METHODS AND RESULTS: Study population consisted of 151,270 patients admitted with ACS from 2002 through 2008 at 411 sites participating in the American Heart Association's Get with the Guidelines (GWTG) program. Demographic variables, physical exam findings, laboratory data, left ventricular ejection fraction, length of stay, in-hospital mortality and discharge medications were compared between diabetic and non-diabetic patients. Temporal trends in compliance with guidelines directed therapy were evaluated. Of 151,270 patients, 48,938 (32%) had diabetes. Overall, diabetic patients were significantly older and more likely non-white. They had significantly more hypertension, atherosclerotic disease, CKD, and LV dysfunction and were more likely to present as NSTEMI. They had longer hospital stay and higher hospital mortality than non-diabetic patients. Diabetic patients were less likely to get LDL checks (65% vs 70%) and less frequently prescribed statins (85% vs 89%), RAAS blockers for LV dysfunction (80% vs 84%) and dual-antiplatelet therapy (69% vs 74%). Diabetic patients were less likely to achieve BP goals before discharge (75% vs 82%). Fewer diabetic patients met first medical contact to PCI time for STEMI (44% vs 52%). Temporal trends, however, showed continued progressive improvement in most performance measures from 2002 to 2008 (all P<.001). CONCLUSIONS: These data from a large cohort of ACS patients demonstrate gaps in compliance with guidelines directed therapy in diabetic patients but also indicate significant and continued improvement in most performance measures over time. Concerted efforts are needed to continue this positive trend.
BACKGROUND: To evaluate and compare baseline characteristics, outcomes and compliance with guideline based therapy at discharge among diabetic and non-diabeticpatients admitted with acute coronary syndromes (ACS). METHODS AND RESULTS: Study population consisted of 151,270 patients admitted with ACS from 2002 through 2008 at 411 sites participating in the American Heart Association's Get with the Guidelines (GWTG) program. Demographic variables, physical exam findings, laboratory data, left ventricular ejection fraction, length of stay, in-hospital mortality and discharge medications were compared between diabetic and non-diabeticpatients. Temporal trends in compliance with guidelines directed therapy were evaluated. Of 151,270 patients, 48,938 (32%) had diabetes. Overall, diabeticpatients were significantly older and more likely non-white. They had significantly more hypertension, atherosclerotic disease, CKD, and LV dysfunction and were more likely to present as NSTEMI. They had longer hospital stay and higher hospital mortality than non-diabeticpatients. Diabeticpatients were less likely to get LDL checks (65% vs 70%) and less frequently prescribed statins (85% vs 89%), RAAS blockers for LV dysfunction (80% vs 84%) and dual-antiplatelet therapy (69% vs 74%). Diabeticpatients were less likely to achieve BP goals before discharge (75% vs 82%). Fewer diabeticpatients met first medical contact to PCI time for STEMI (44% vs 52%). Temporal trends, however, showed continued progressive improvement in most performance measures from 2002 to 2008 (all P<.001). CONCLUSIONS: These data from a large cohort of ACS patients demonstrate gaps in compliance with guidelines directed therapy in diabeticpatients but also indicate significant and continued improvement in most performance measures over time. Concerted efforts are needed to continue this positive trend.