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Observational Study
. 2020 Dec;43(12):1352-1361.
doi: 10.1002/clc.23476. Epub 2020 Nov 4.

Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction

José C Nicolau  1 , David Brieger  2 , Ruth Owen  3 , Remo H M Furtado  1   4 , Shaun G Goodman  5 , Mauricio G Cohen  6 , Tabassome Simon  7   8 , Dirk Westermann  9   10 , Christopher B Granger  11 , Richard Grieve  3 , Satoshi Yasuda  12 , Jiyan Chen  13 , Katarina Hedman  14 , Carl Mellström  14 , Gunnar Brandrup-Wognsen  14 , Stuart J Pocock  3
Affiliations
Observational Study

Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction

José C Nicolau et al. Clin Cardiol. 2020 Dec.

Abstract

Background: Diabetes mellitus (DM) is associated with increased cardiovascular (CV) risk. We compared health-related quality of life (HRQoL), healthcare resource utilization (HRU), and clinical outcomes of stable post-myocardial infarction (MI) patients with and without DM.

Hypothesis: In post-MI patients, DM is associated with worse HRQoL, increased HRU, and worse clinical outcomes.

Methods: The prospective, observational long-term risk, clinical management, and healthcare Resource utilization of stable coronary artery disease study obtained data from 8968 patients aged ≥50 years 1 to 3 years post-MI (369 centers; 25 countries). Patients with ≥1 of the following risk factors were included: age ≥65 years, history of a second MI >1 year before enrollment, multivessel coronary artery disease, creatinine clearance ≥15 and <60 mL/min, and DM treated with medication. Self-reported health status was assessed at baseline, 1 and 2 years and converted to EQ-5D scores. The main outcome measures were baseline HRQoL and HRU during follow-up.

Results: DM at enrollment was 33% (2959 patients, 869 insulin treated). Mean baseline EQ-5D score (0.86 vs 0.82; P < .0001) was higher; mean number of hospitalizations (0.38 vs 0.50, P < .0001) and mean length of stay (LoS; 9.3 vs 11.5; P = .001) were lower in patients without vs with DM. All-cause death and the composite of CV death, MI, and stroke were significantly higher in DM patients, with adjusted 2-year rate ratios of 1.43 (P < .01) and 1.55 (P < .001), respectively.

Conclusions: Stable post-MI patients with DM (especially insulin treated) had poorer EQ-5D scores, higher hospitalization rates and LoS, and worse clinical outcomes vs those without DM. Strategies focusing specifically on this high-risk population should be developed to improve outcomes.

Trial registration: ClinicalTrials.gov: NCT01866904 (https://clinicaltrials.gov).

Keywords: cardiovascular events; diabetes; healthcare resource utilization; myocardial infarction; quality of life.

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Figures

FIGURE 1
FIGURE 1
Quality of life and healthcare utilization. A, Quality of life. B, Hospitalizations. C, Hospital stay. Abbreviations: CI, confidence interval; EQ‐5D, EuroQol Research Foundation survey instrument for measuring self‐reported health status in 5 dimensions
See this image and copyright information in PMC

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