Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome: a nationwide study

Ida Gustafsson; Anders Hvelplund; Kim Wadt Hansen; Søren Galatius; Mette Madsen; Jan Skov Jensen; Hans-Henrik Tilsted; Christian Juhl Terkelsen; Lisette Okkels Jensen; Erik Jørgensen; Jan Kyst Madsen; Steen Zabell Abildstrøm

doi:10.1136/openhrt-2014-000165

Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome: a nationwide study

Ida Gustafsson, Anders Hvelplund, Kim Wadt Hansen, Søren Galatius, Mette Madsen, Jan Skov Jensen, Hans-Henrik Tilsted, Christian Juhl Terkelsen, Lisette Okkels Jensen, Erik Jørgensen, Jan Kyst Madsen, Steen Zabell Abildstrøm

Abstract

BACKGROUND: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes.

METHODS AND RESULTS: The study is a nationwide cohort study linking Danish national registries containing information on healthcare. The study population comprises all patients hospitalised with first-time ACS in Denmark during 2005-2007 (N=24 952). Diabetes was defined as claiming of a prescription for insulin and/or oral hypoglycaemic agents within 6 months prior to the ACS event. Diabetes was present in 2813 (11%) patients. Compared with patients without diabetes, patients with diabetes were older (mean 69 vs 67 years, p<0.0001), less often males (60% vs 64%, p=0.0001) and had more comorbidity. Fewer patients with diabetes underwent CAG: cumulative incidence 64% vs 74% for patients without diabetes, HR=0.72 (95% CI 0.69 to 0.76, p<0.0001); adjusted for age, sex, previous revascularisation and comorbidity HR=0.78 (95% CI 0.74 to 0.82, p<0.0001). More patients with diabetes had CAG showing two-vessel or three-vessel disease (53% vs 38%, p<0.0001). However, revascularisation after CAG revealing multivessel disease was less likely in patients with diabetes (multivariable adjusted HR=0.76, 95% CI 0.68 to 0.85, p<0.0001).

CONCLUSIONS: In this nationwide cohort of patients with incident ACS, patients with diabetes were found to be less aggressively managed by an invasive treatment strategy. The factors underlying the decision to defer an invasive strategy in patients with diabetes are unclear and merit further investigation.

Originalsprog	Engelsk
Artikelnummer	e000165
Tidsskrift	Open Heart
Vol/bind	2
Udgave nummer	1
Sider (fra-til)	1-9
Antal sider	9
ISSN	2398-595X
DOI	https://doi.org/10.1136/openhrt-2014-000165
Status	Udgivet - 2015

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10.1136/openhrt-2014-000165Licens: CC BY-NC

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Gustafsson, I., Hvelplund, A., Hansen, K. W., Galatius, S., Madsen, M., Jensen, J. S., Tilsted, H-H., Terkelsen, C. J., Jensen, L. O., Jørgensen, E., Madsen, J. K., & Abildstrøm, S. Z. (2015). Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome: a nationwide study. Open Heart, 2(1), 1-9. [e000165]. https://doi.org/10.1136/openhrt-2014-000165

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title = "Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome: a nationwide study",

abstract = "BACKGROUND: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes.METHODS AND RESULTS: The study is a nationwide cohort study linking Danish national registries containing information on healthcare. The study population comprises all patients hospitalised with first-time ACS in Denmark during 2005-2007 (N=24 952). Diabetes was defined as claiming of a prescription for insulin and/or oral hypoglycaemic agents within 6 months prior to the ACS event. Diabetes was present in 2813 (11%) patients. Compared with patients without diabetes, patients with diabetes were older (mean 69 vs 67 years, p<0.0001), less often males (60% vs 64%, p=0.0001) and had more comorbidity. Fewer patients with diabetes underwent CAG: cumulative incidence 64% vs 74% for patients without diabetes, HR=0.72 (95% CI 0.69 to 0.76, p<0.0001); adjusted for age, sex, previous revascularisation and comorbidity HR=0.78 (95% CI 0.74 to 0.82, p<0.0001). More patients with diabetes had CAG showing two-vessel or three-vessel disease (53% vs 38%, p<0.0001). However, revascularisation after CAG revealing multivessel disease was less likely in patients with diabetes (multivariable adjusted HR=0.76, 95% CI 0.68 to 0.85, p<0.0001).CONCLUSIONS: In this nationwide cohort of patients with incident ACS, patients with diabetes were found to be less aggressively managed by an invasive treatment strategy. The factors underlying the decision to defer an invasive strategy in patients with diabetes are unclear and merit further investigation.",

author = "Ida Gustafsson and Anders Hvelplund and Hansen, {Kim Wadt} and S{\o}ren Galatius and Mette Madsen and Jensen, {Jan Skov} and Hans-Henrik Tilsted and Terkelsen, {Christian Juhl} and Jensen, {Lisette Okkels} and Erik J{\o}rgensen and Madsen, {Jan Kyst} and Abildstr{\o}m, {Steen Zabell}",

year = "2015",

doi = "10.1136/openhrt-2014-000165",

language = "English",

volume = "2",

pages = "1--9",

journal = "Open Heart",

issn = "2053-3624",

publisher = "BMJ",

number = "1",

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TY - JOUR

T1 - Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome

T2 - a nationwide study

AU - Gustafsson, Ida

AU - Hvelplund, Anders

AU - Hansen, Kim Wadt

AU - Galatius, Søren

AU - Madsen, Mette

AU - Jensen, Jan Skov

AU - Tilsted, Hans-Henrik

AU - Terkelsen, Christian Juhl

AU - Jensen, Lisette Okkels

AU - Jørgensen, Erik

AU - Madsen, Jan Kyst

AU - Abildstrøm, Steen Zabell

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes.METHODS AND RESULTS: The study is a nationwide cohort study linking Danish national registries containing information on healthcare. The study population comprises all patients hospitalised with first-time ACS in Denmark during 2005-2007 (N=24 952). Diabetes was defined as claiming of a prescription for insulin and/or oral hypoglycaemic agents within 6 months prior to the ACS event. Diabetes was present in 2813 (11%) patients. Compared with patients without diabetes, patients with diabetes were older (mean 69 vs 67 years, p<0.0001), less often males (60% vs 64%, p=0.0001) and had more comorbidity. Fewer patients with diabetes underwent CAG: cumulative incidence 64% vs 74% for patients without diabetes, HR=0.72 (95% CI 0.69 to 0.76, p<0.0001); adjusted for age, sex, previous revascularisation and comorbidity HR=0.78 (95% CI 0.74 to 0.82, p<0.0001). More patients with diabetes had CAG showing two-vessel or three-vessel disease (53% vs 38%, p<0.0001). However, revascularisation after CAG revealing multivessel disease was less likely in patients with diabetes (multivariable adjusted HR=0.76, 95% CI 0.68 to 0.85, p<0.0001).CONCLUSIONS: In this nationwide cohort of patients with incident ACS, patients with diabetes were found to be less aggressively managed by an invasive treatment strategy. The factors underlying the decision to defer an invasive strategy in patients with diabetes are unclear and merit further investigation.

AB - BACKGROUND: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes.METHODS AND RESULTS: The study is a nationwide cohort study linking Danish national registries containing information on healthcare. The study population comprises all patients hospitalised with first-time ACS in Denmark during 2005-2007 (N=24 952). Diabetes was defined as claiming of a prescription for insulin and/or oral hypoglycaemic agents within 6 months prior to the ACS event. Diabetes was present in 2813 (11%) patients. Compared with patients without diabetes, patients with diabetes were older (mean 69 vs 67 years, p<0.0001), less often males (60% vs 64%, p=0.0001) and had more comorbidity. Fewer patients with diabetes underwent CAG: cumulative incidence 64% vs 74% for patients without diabetes, HR=0.72 (95% CI 0.69 to 0.76, p<0.0001); adjusted for age, sex, previous revascularisation and comorbidity HR=0.78 (95% CI 0.74 to 0.82, p<0.0001). More patients with diabetes had CAG showing two-vessel or three-vessel disease (53% vs 38%, p<0.0001). However, revascularisation after CAG revealing multivessel disease was less likely in patients with diabetes (multivariable adjusted HR=0.76, 95% CI 0.68 to 0.85, p<0.0001).CONCLUSIONS: In this nationwide cohort of patients with incident ACS, patients with diabetes were found to be less aggressively managed by an invasive treatment strategy. The factors underlying the decision to defer an invasive strategy in patients with diabetes are unclear and merit further investigation.

U2 - 10.1136/openhrt-2014-000165

DO - 10.1136/openhrt-2014-000165

M3 - Journal article

C2 - 25685362

SN - 2053-3624

VL - 2

SP - 1

EP - 9

JO - Open Heart

JF - Open Heart

IS - 1

M1 - e000165

ER -

Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome: a nationwide study

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