Key result
Within 100 days post-discharge, 27% of patients with T2DM and newly diagnosed CVD were readmitted, and while post-discharge pharmacotherapy improved moderately, significant gaps in clinical assessment and diabetes management remained.
Why the study?
Hospital discharge practices and follow-up care quality for patients with type 2 diabetes and newly diagnosed cardiovascular disease are inadequately described, with potential gaps in clinical and laboratory assessments and treatment adjustments.
Cohort (n=1,482)
Patients with type 2 diabetes and newly diagnosed cardiovascular disease experience high rates of early hospital readmission and sub-optimal optimization of secondary prevention therapies, highlighting a critical need for standardized discharge and follow-up protocols.
High early readmission signals post-discharge vulnerabilities in T2DM with new CVD; supports trials of standardized follow-up protocols.
OBJECTIVE: To examine hospital discharge practices, including clinical and laboratory assessments, in patients with type 2 diabetes mellitus (T2DM) following their first hospitalisation for cardiovascular disease (CVD), and to explore the association of these practices with adverse events, defined as hospital readmission, emergency department visits and mortality. DESIGN: Retrospective cohort study. SETTING: Follow-up for 100 days after a newly diagnosed CVD among patients with T2DM in Region Halland, Sweden. PARTICIPANT: A total of 1482 patients with T2DM and a new diagnosis of CVD during hospitalisation were included. Patients were followed from hospital discharge for up to 100 days. Inclusion criteria were a hospital discharge diagnosis of CVD and a prior diagnosis of T2DM. Patients with incomplete discharge data or without follow-up records were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the overall risk of serious adverse events after hospital discharge, including mortality, hospital readmission and ED encounters, within 100 days of discharge. Secondary outcomes included primary care visits and pharmacotherapy adjustments for CVD and T2DM during the same period. RESULTS: The readmission rate within the study period was 27%, while 86% of patients visited primary care within 100 days after discharge. Cardiovascular pharmacotherapy increased, with beta-blocker usage rising to 73% and statin use reaching 82%. A significant, though modest, increase in pharmacotherapy for T2DM was observed, with metformin use increasing from 53% to 57% (p<0.001). Laboratory test results and clinical measurements at discharge, including missing glycated haemoglobin values (68%) and elevated systolic blood pressures, were associated with modest treatment adjustments at discharge, suggesting potential gaps in discharge practices and documentation. CONCLUSIONS: Despite moderate improvements in postdischarge pharmacotherapy, limited changes in diabetes management suggest room for optimisation. The findings emphasise the need for improved discharge planning and continuity of care. Future research should investigate the effects of standardised discharge protocols on treatment outcomes and readmission rates for this patient group.
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Agvall et al. (2025) conducted a cohort in Type 2 diabetes mellitus (T2DM) and newly diagnosed cardiovascular disease (CVD) (n=1,482). Hospital discharge practices and follow-up care was evaluated on Overall risk of serious adverse events after hospital discharge, including mortality, hospital readmission, and emergency department encounters, within 100 days of discharge. Within 100 days post-discharge, 27% of patients with T2DM and newly diagnosed CVD were readmitted, and while post-discharge pharmacotherapy improved moderately, significant gaps in clinical assessment and diabetes management remained.
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