HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brogan, G. X. Articles by Roe, M. T. Search for Related Content PubMed PubMed Citation Articles by Brogan, G. X., Jr Articles by Roe, M. T. Social Bookmarking                What's this?

Treatment Disparities in the Care of Patients With and Without Diabetes Presenting With Non–ST-Segment Elevation Acute Coronary Syndromes

¹ Department of Emergency Medicine, New York University School of Medicine/North Shore Long Island Jewish Health System, Plainview, New York
² Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
³ Cleveland Clinic, Cleveland, Ohio
⁴ Division of Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
⁵ Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio
⁶ Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
⁷ Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York

Address correspondence and reprint requests to Gerard X. Brogan, Jr., MD, Department of Emergency Medicine, North Shore University Hospital, 888 Old Country Rd., Plainview, NY 11803. E-mail: gbrogan{at}nshs.edu

OBJECTIVE—The objective of this study was to characterize treatment patterns among patients with diabetes presenting with non–ST-segment elevation (NSTE) acute coronary syndromes (ACSs).

RESEARCH DESIGN AND METHODS—We compared adherence to treatment recommendations from the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for NSTE ACS among 46,410 patients from 413 U.S. hospitals that were included in the Can Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Patients were stratified as nondiabetic, non–insulin-dependent diabetic (type 2 diabetic), and insulin-treated diabetic.

RESULTS—Insulin-treated diabetic patients were less likely than nondiabetic patients to receive aspirin (adjusted odds ratio 0.83 [95% CI 0.74–0.93]), ß-blockers (0.89 [0.83–0.96]), heparin (0.90 [0.83–0.98]), and glycoprotein IIb/IIIa inhibitors (0.86 [0.79–0.93]). Type 2 diabetic patients were treated similarly to nondiabetic patients. After adjustment for differences in clinical characteristics, insulin-treated diabetic patients were significantly less likely than nondiabetic patients to receive cardiac catheterization within 48 h of presentation (0.80 [0.74–0.86]) or percutaneous coronary intervention (0.87 [0.82–0.94]). Compared with nondiabetic patients, insulin-treated diabetic and type 2 diabetic patients were more likely to undergo coronary artery bypass grafting (1.34 [1.21–1.49] and 1.35 [1.26–1.44]). In-hospital mortality rates were higher in insulin-treated diabetic (6.8%) and type 2 diabetic (5.4%) than in nondiabetic (4.4%) patients.

CONCLUSIONS—Diabetic patients have a higher risk of mortality than nondiabetic patients, yet physicians adhere to the ACC/AHA NSTE ACS guidelines less often when treating diabetic patients, particularly insulin-treated diabetic patients. Increased use of guideline-recommended therapies and early invasive management strategies in diabetic patients may improve their outcomes.

Abbreviations: ACC, American College of Cardiology • ACS, acute coronary syndrome • AHA, American Heart Association • AOR, adjusted odds ratio • CRUSADE, Can Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines • NSTE, non–ST-segment elevation • PCI, percutaneous coronary intervention

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				P. Wing, G. J. Forte, M. G. Dionne, and J. R. Christina Projections of the Supply of and Demand for Podiatric Physicians in the United States, 2005 to 2030 J Am Podiatr Med Assoc, July 1, 2008; 98(4): 330 - 336. [Abstract] [Full Text] [PDF]

				R. H. Mehta, S. Milford-Beland, E. D. Peterson, D. L. Bhatt, M. E. Farkouh, G. X. Brogan, W. B. Gibler, E. M. Ohman, and M. T. Roe Characterizing Young Patients With Diabetes and Non-ST-Segment Elevation Acute Coronary Syndromes Diabetes Care, March 1, 2007; 30(3): 731 - 733. [Full Text] [PDF]

				H. Soran, B. Barzangy, and N. Younis The benefits of insulin therapy following acute myocardial infarction revisited QJM, September 1, 2006; 99(9): 635 - 637. [Full Text] [PDF]