Audit of patients with type 2 diabetes following a critical cardiac event

BACKGROUND: Evidence indicates that type 2 diabetes leads to complications such as a cardiac event, which often requires admission to a coronary care unit (CCU). Although there is a considerable body of knowledge about the management and characteristics of people with type 2 diabetes and myocardial infraction, there are few reports of the disease and demographic characteristics of the entire group of patients with diabetes admitted to a CCU. PURPOSE: To gain greater understanding of the characteristics of patients with diabetes hospitalized for a critical cardiac event in order to assist in the development of an appropriate self-management programme for CCU patients with diabetes. METHODS: Data were collected retrospectively from computerized records and charts of all patients with diabetes admitted to the CCU from 1 January 2000 to 31 December 2003. FINDINGS: The proportion of type 2 diabetic patients admitted to CCU with a critical cardiac event over the 4-year study period was consistent at 14.7%, 233 in 1589 patients. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days compared with only 6% of CCU patients without diabetes. Predictors for readmission and length of stay were also examined. CONCLUSIONS: A considerable proportion of a CCU population had type 2 diabetes and these patients had significantly higher readmission rates. The implications of this study for the development of a self-management programme for patients with diabetes who experienced a critical cardiac event are discussed. IMPLICATIONS FOR PRACTICE: Innovative programmes are required to reduce the rate of readmission for patients with both diabetes and a critical cardiac event. These should: 1 ensure transition programmes, such as self-management, commence within the CCU environment and continue following discharge, and 2 integrate diabetes and cardiac self-management programmes to condense the large amount of information provided to patients for managing two serious conditions.