Abstract

Objective To compare time trends in mortality and treatment patterns between patients with and without diabetes based on the Swedish register of coronary care (RIKS-HIA).

Design, Settings and Patients Post myocardial infarction mortality is high in diabetic patients who seem to get less of evidence based treatment. Mortality and treatment 1995-1998 and 1999-2002 were studied in 70 882 patients (age < 80 years), 14 873 with diabetes, and a first registry recorded acute myocardial infarction, following adjustments for differences in clinical and other parameters.

Results One-year mortality decreased 1995 - 2002 from 16.6 % to 12.1 % in patients without and 29.7 % to 19.7 % in those with diabetes. Patients with diabetes had an adjusted relative 1-year mortality risk of 1.44 (95%CI 1.36-1.52) in 1995-1998 and 1.31 (95%CI 1.24-1.38) in 1999-2002. Despite improved preadmission and in-hospital treatment diabetic patients were less often offered acute reperfusion therapy (adjusted OR 0.85, 95% CI 0.80-0.90), acute revascularization (adjusted OR 0.78, 95% CI 0.69-0.87) or revascularization within 14 days (OR 0.80, 95% CI 0.75-0.85), aspirin (OR 0.90, 95%CI 0.84-0.98) and lipid-lowering treatment at discharge (OR 0.81, 95% CI 0.77-0.86).

Conclusion Despite a clear improvement in treatment and outcome of myocardial survival in patients with diabetes mortality remains higher than in patients without diabetes. Part of the excess mortality may be explained by co-morbidities and the diabetes disease itself but too little use of evidence based treatment still contributes underlining the importance of improved management of diabetic patients.