Impact of different clinic models on cardiometabolic risk optimisation and cardioprotective therapies in post myocardial infarction patients with type 2 diabetes

Abstract Background Individuals with diabetes who survive a myocardial infarction are at high risk of developing recurrent cardiovascular events (1). Optimising glycaemic and lipid control and appropriate use of cardioprotective therapies are critical in reducing morbidity and mortality. Purpose To evaluate the impact of four different clinics on cardiometabolic risk optimisation and the use of cardioprotective SGLT2 inhibitors (SGLT2i) in post–myocardial infarction patients with type 2 diabetes (T2D) using real-world data. Methods This retrospective cross-sectional study involved post-MI patients with T2D at Leeds Teaching Hospitals NHS Trust. Patients were included from the following clinics: the cardiology pharmacist-led cardiometabolic clinic (Ph-CARDMET) (supported by a cardiologist + endocrinologist), the physician-led cardiometabolic clinic (MD-CARDMET), the cardiology pharmacist-led post-myocardial infarction medicine-optimisation clinic (Ph-IHD) (supported by a cardiologist), and the physician-led ischaemic heart disease clinic (MD-IHD) during the period from mid-2021 to 2024. Data were obtained at admission to hospital with STEMI or NSTEMI and at 3–9 months post clinic visit following MI. Patients were screened using the Myocardial Ischaemia National Audit Project (MINAP) registry and the electronic health records system (PPM+ and EPRO). We analysed the demographics, HbA1c, LDL-C, non-HDL-C, and the use of SGLT2i. Descriptive statistics were used to summarise the results. Results Data for 200 patients was analysed (Table 1). The highest relative reduction in HbA1c at 3-9 months post clinic visit from admission was seen among patients who were reviewed in the Ph-CARDMET (-16%) and MD-CARDMET (-13%). The change in HbA1c in the Ph-IHD and MD-IHD clinics was insignificant. Ph-CARDMET clinic had the highest proportion of patients with an HbA1c 58 mmol/mol (67%). At 3-9 months post clinic visit, the proportions of patients achieving the LDL-C target (1.8 mmol/L) and non-HDL-C target ( 2.5 mmol/L) were 73% and 66% in the Ph-CARDMET clinic, 60% and 62% in the Ph-IHD, 57% and 46% in the MD-CARDMET, followed by 50% and 38% in IHD clinic, respectively. Patients attending the cardiometabolic clinics were more likely to be on SGLT2i than those attending standard post MI clinics (84% vs. 62%, respectively). The cardiometabolic clinics evaluated and initiated all patients on SGLT2i where appropriate. 16% of patients were clinically not suitable for SGLT2i (e.g. side effect, absence of license at the time). Conclusions In this cohort, dedicated post MI cardiometabolic clinics, provided better optimisation of cardiometabolic risk factors and cardioprotective therapies. They achieved better glycaemic control, lipid optimisation and SGLT2i initiation than standard post MI clinics. The cardiology pharmacist clinics (supported by physicians) performed well, increased capacity, and achieved better overall lipid lowering compared to other clinics.Demographics and risk factors by clinicFor image description, please refer to the figure legend and surrounding text.