Document resource
Introduction Diabetes mellitus (DM) remains a prevalent condition worldwide and a significant risk factor for atherosclerotic cardiovascular disease. Recent evidence suggest the use of glucose lowering therapies with cardiovascular benefit in optimising the cardiometabolic profile of patients with type 2 diabetes mellitus. However, uptake remains low, particularly in patients presenting with acute coronary syndrome (ACS). This study was carried out to assess the impact of a novel cardiodiabetes service for the management of patients with diabetes mellitus presenting with acute coronary syndromes.Purpose To assess the impact of a dedicated cardiodiabetic service on (i) screening and monitoring of patients for DM via a valid glycated haemoglobin (HbA1c) (ii) early optimisation of glucose lowering therapies with proven cardiovascular benefit and (iii) impact on reno-cardiovascular outcomes including all cause death and hospitalisations.Methods A retrospective, observational, registry based analysis was performed among patients presenting with ACS and DM to a regional heart centre, before and after the implementation of a cardiodiabetes service. Intergroup comparison was made for the proportion of patients having a valid HbA1c during admission, initiation of guideline recommended glucose lowering therapies and outcome events analysis using Chi-square test, Poisson regression and Wald test with survival analysis performed using Kaplan-Meier method.Results At median follow up of 29.7 months, a valid HbA1c measurement at baseline was lower in the pre-intervention compared to the post-intervention group (556/711 [78.2%] vs 302/362 [83.4%], p=0.043) while more patients in the post-intervention group were prescribed sodium glucose co-transporter inhibitors (297/362 [82.0%] vs 359/711 [50.5%]. All-cause mortality (5.2 vs 12.3 [events/100-patient-years], relative ratio [RR] 0.42, 95% confidence interval [CI] 0.28–0.61, and p<0.001), first events of acute kidney injury (AKI) (10.0 vs 13.0, RR 0.77, CI 0.57–1.03, p=0.090), all events of AKI (16.6 vs 22.1, RR 0.75, CI 0.60–0.94, p=0.015) and all-cause events requiring urgent hospitalisation (47.1 vs 64.0 events per 100 patient-years, RR 0.74, CI 0.64–0.84, p<0.001) were significantly lower in the post-intervention group.Abstract 2-044 Figure 1Prescription of SGLT2is among eligible patients with T2DM and ACS on a yearly: cardiodiabetic programme established in 2021. Note: cardiodiabetic clinic started in summer 2021 and active in-reach service commenced in autumn 2022Abstract 2-044 Figure 2Kaplan-Meier graphs of first events of all cause death (A), acute kidney injury (B), hospitalisation for heart failure (C), myocardial infarction (D), hospitalisation for unstable angina (E) and stroke/transient ischaemic attack (TIA) (F)Conclusion The introduction of a joint-speciality cardiodiabetes service suggested improved care and survival of patients with reduction in reno-cardiovascular events in patients with DM when presenting with ACS.