Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010

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Abstract

Objective: To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. Methods: We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. Results:26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sexstandardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88). Conclusions: Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.
Original languageEnglish
Pages (from-to)1318-1324
JournalHeart
Volume101
Issue number16
DOIs
Publication statusPublished - 2015

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Myocardial Infarction
Logistic Models
Information Storage and Retrieval
Chronic Renal Insufficiency
Information Systems
Coronary Disease
Comorbidity
Heart Failure
Demography
Population
Therapeutics

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@article{8187ed8259b14dcbae6285815a04716c,
title = "Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010",
abstract = "Objective: To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. Methods: We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. Results:26 610 hospitalised incident MI cases were identified, 24.8{\%} of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65{\%}, in 1998-2001, to 3.96{\%} by 2008-2010. Age- and sexstandardised case fatality declined at a greater rate in those with diabetes (-10.6{\%}/year, 95{\%} CI -12.8{\%} to -8.2{\%}) compared to non-diabetics (-6.9{\%}/year, 95{\%} CI -8.3{\%} to -5.3{\%}; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95{\%} CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95{\%} CI 0.46 to 0.88). Conclusions: Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.",
author = "Lee Nedkoff and Matthew Knuiman and Joe Hung and Tom Briffa",
year = "2015",
doi = "10.1136/heartjnl-2015-307627",
language = "English",
volume = "101",
pages = "1318--1324",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "16",

}

TY - JOUR

T1 - Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010

AU - Nedkoff, Lee

AU - Knuiman, Matthew

AU - Hung, Joe

AU - Briffa, Tom

PY - 2015

Y1 - 2015

N2 - Objective: To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. Methods: We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. Results:26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sexstandardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88). Conclusions: Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.

AB - Objective: To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. Methods: We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. Results:26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sexstandardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88). Conclusions: Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.

U2 - 10.1136/heartjnl-2015-307627

DO - 10.1136/heartjnl-2015-307627

M3 - Article

VL - 101

SP - 1318

EP - 1324

JO - Heart

JF - Heart

SN - 1355-6037

IS - 16

ER -