Aims We evaluated variation in treatment for, and outcomes following, myocardial infarction (MI) by diabetes status, sex and socioeconomic disadvantage.
Methods We included all people aged ≥30 years who were discharged alive from hospital following MI between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=43 272). We assessed receipt of inpatient procedures and discharge dispensing of cardioprotective medications for each admission, as well as 1-year all-cause, cardiovascular, and MI readmission rates and 1-year all-cause mortality.
Results Risk of all-cause (HR: 1.22 (1.19–1.26)), cardiovascular (1.29 (1.25–1.34)), MI (1.52 (1.43–1.62)) and heart failure readmission (1.62 (1.50–1.75)) and mortality (1.18 (1.11–1.26)) were higher in people with diabetes. Males and people in more disadvantaged areas were at increased risk of readmission and mortality following MI. People with diabetes (vs without) were more likely to receive coronary artery bypass grafting (CABG) but less likely to receive percutaneous coronary intervention (PCI) during, or within 30 days of, their index admission. Females were less likely to receive either (eg, 87% of males with a STEMI received PCI or CABG vs 70% of females), and people in more disadvantaged areas were less likely to receive PCI. People with diabetes, males and people in more disadvantaged areas were more likely to be dispensed cardioprotective medications at or within 90 days of discharge.
Conclusions Following an MI, people with diabetes and males had poorer outcomes but received more intensive cardiovascular treatments. However, socioeconomic disadvantage was associated with both less intensive inpatient treatment and poorer outcomes.
- CORONARY HEART DISEASE
- DIABETES MELLITUS
- SOCIAL CLASS
Data availability statement
No data are available. The data analysed in this study are unavailable due to privacy concerns.
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DJM and JES are joint senior authors.
Presented at Parts of this work were presented in abstract form at the American Diabetes Association’s 81st Scientific Sessions (June 2021).
Contributors JM contributed to the design of the study and interpretation of data, performed the statistical analysis and literature search and wrote and revised the manuscript. JI, SJW, and JSB contributed to the design of the study, acquisition and interpretation of data and revision of the manuscript. QH contributed to interpretation of data and revision of the manuscript. DJM and JES are principal investigators and made contributions to the design of the study, interpretation of the data and revision of the manuscript. JM is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final version of this manuscript.
Funding JM is supported by an Australian Government Research Training ProgramProgramme (RTP) Scholarship and Monash Graduate Excellence Scholarship. JSB is supported by a National Health and Medical Research Council Dementia Leadership Fellowship (GNT1140298). JES is supported by a National Health and Medical Research Council Investigator Grant (APP1173952). This work is partially supported by the Victorian Government’s Operational Infrastructure Support Programme.
Competing interests Duality of interest: JI has consulted for AstraZeneca Australia and Amgen. JSB has received research grant funding paid to his employer from National Health and Medical Research Council, Victorian Government Department of Health, Dementia Australia Research Foundation, Yulgilbar Foundation, Dementia Centre for Research Collaboration, Aged Care Quality and Safety Commission, GlaxoSmithKline Supported Studies Programme, and aged care provider organisations unrelated to this work. JES has received honoraria from: Astra Zeneca, Sanofi, Novo Nordisk, MSD; Eli Lilly, Abbott, Mylan and Boehringer Ingelheim.
Provenance and peer review Not commissioned; internally peer reviewed.
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