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Post-heart attack mortality soars in diabetes untreated at discharge.

Washington -- Diabetic patients who had myocardial infarctions and had not resumed their antihyperglycemia medications by discharge were 24% more likely to die within 1 year than were similar patients who had resumed their medications at discharge, according to a report during a poster presentation at the annual scientific sessions of the American Diabetes Association.

The increased risk of death was especially telling in the first 30 days after discharge, said Dr. Silvio Inzucchi, principal investigator and professor of medicine at Yale University, New Haven, Conn. He and his associates reviewed the charts of Medicare patients aged 65 years and older in the National Heart Care Project. All of the patients had a confirmed acute MI and previously documented diabetes treated with antihyperglycemic agents. The study excluded those who died before discharge, were transferred to another facility, or needed long-term hemodialysis.

Of the 8,751 patient charts, 1,170 (13%) indicated patients had not resumed their diabetes medications by discharge. Within 1 year of discharge, 38% of these patients had died. The 1-year mortality rate was 28% in the 7,581 who were taking their diabetes medications at discharge.

Notably, 36% of the deaths occurred within the first 30 days after hospital discharge in patients who had not resumed diabetes medications at discharge, compared with 23% of the deaths in those discharged on diabetes medications. The difference was statistically significant after multivariate Cox analysis for 78 clinical variables, including admission glucose, complications, and ventricular function, was used to evaluate the association between discharge on diabetes therapy and outcome. Patients who had not resumed their antihyperglycemic agents at discharge also were more likely to be discharged without receiving statins, [beta]-blockers, ACE inhibitors, and aspirin.

The study is limited by the lack of data about changes in patients' prescriptions after discharge. It is unclear whether patients immediately visited their primary care doctors and resumed their antihyperglycemic medications.

Dr. Inzucchi said cardiologists need to address diabetes during discharge planning, if only to have patients follow up with their primary doctors.

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Title Annotation:Cardiovascular Medicine
Author:Gildea, Marianne Reid
Publication:Family Practice News
Geographic Code:1USA
Date:Aug 15, 2006
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