Use of secondary prevention pharmacotherapy after first myocardial infarction in patients with diabetes mellitus
Key result
Patients with diabetes mellitus claimed significantly less acetylsalicylic acid (OR 0.81) and clopidogrel (OR 0.91) for secondary prevention after a first myocardial infarction compared to patients without diabetes.
Why the study?
Are patients with diabetes mellitus less likely to receive evidence-based secondary prevention pharmacotherapy after a first myocardial infarction compared to those without diabetes?
Population
78,230 patients aged ≥30 years admitted with first myocardial infarction in Denmark during 1997-2006, mean…
Comparison
Presence of diabetes mellitus vs Patients without diabetes mellitus
Design
Cohort
Follow-up
Up to 180 days post-discharge
Authors
Discussion
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Member takes
Implication
May indicate underuse of antiplatelet therapy in diabetic post-MI patients; leaves open whether targeted strategies improve secondary prevention uptake.
Study Design
Type
Cohort (n=78,230)
Multicenter
Yes
Structured PICO
Are patients with diabetes mellitus less likely to receive evidence-based secondary prevention pharmacotherapy after a first myocardial infarction compared to those without diabetes?
P
Population
78,230 patients aged 30 years or older admitted with a first myocardial infarction in Denmark, followed for up to 180 days post-discharge to assess initiation of secondary prevention pharmacotherapy.
E
Exposure
Presence of diabetes mellitus (assessing initiation of secondary prevention pharmacotherapy including acetylsalicylic acid, ACEi/ARB, beta-blockers, clopidogrel, and statins)
C
Comparator
Patients without diabetes mellitus
O
Outcome
Initiation of acetylsalicylic acid, ACEi/ARB, beta-blockers, and clopidogrel within 90 days, and statins within 180 days of discharge
Main Result
Odds Ratio: 0.81 (95% CI 0.74–0.88)
Absolute Event Rate: 64.3% vs 70.5%
Despite overall increases in secondary prevention pharmacotherapy after MI, patients with diabetes receive significantly less antiplatelet therapy than those without diabetes.
Limitations
- Observational study design lacking information on important confounders like left ventricular ejection fraction, renal function, and contraindications for treatment
- Unknown number of patients who initiated secondary prevention therapy during hospitalization but did not tolerate treatment
- Definition of diabetes mellitus was based on prescription claims for glucose-lowering drugs, meaning diet-treated patients were misclassified
- Data collected only from Denmark, which may limit generalizability to other healthcare systems
Cite This Study
Jørgensen et al. (2014) conducted a cohort in First myocardial infarction (n=78,230). Diabetes mellitus vs. No diabetes mellitus was evaluated on Claiming acetylsalicylic acid (ASA) prescription within 90 days of discharge (2003-2006 period) (OR 0.81, 95% CI 0.74-0.88). Patients with diabetes mellitus claimed significantly less acetylsalicylic acid (OR 0.81) and clopidogrel (OR 0.91) for secondary prevention after a first myocardial infarction compared to patients without diabetes.