WASHINGTON — Diabetic patients who had myocardial infarctions and had not resumed their antihyperglycemia medications by discharge were 24% more likely to die within 1 year as were similar patients who had resumed their medications at discharge.
The increased risk of death was especially telling in the first 30 days after discharge. “I was struck by the findings,” said Dr. Silvio Inzucchi, principal investigator and professor of medicine at Yale University, New Haven, Conn., during a poster presentation at the annual scientific sessions of the American Diabetes Association.
Dr. Inzucchi and his associates reviewed charts of Medicare patients aged 65 years and older in the National Heart Care Project.
All patients had a confirmed acute MI and previously documented diabetes treated with antihyperglycemic agents. The study did not include patients who died before discharge, were transferred to another facility, or needed long-term hemodialysis.
Of the 8,751 patient charts, 1,170 (13%) indicated patients had not resumed their diabetes medications by discharge. Within 1 year of discharge, 38% of these patients had died. The 1-year mortality was 28% in the 7,581 patients who were taking their diabetes medications at discharge.
Notably, 36% of the deaths occurred within the first 30 days after hospital discharge among patients who had not resumed diabetes medications at discharge, compared with 23% of the deaths in those discharged on diabetes medications.
The difference was statistically significant after multivariate Cox analysis for 78 clinical variables—including admission glucose, complications, ventricular function, and concurrent medications—was used to evaluate the association between discharge on diabetes therapy and outcome.
Investigators also found that patients who had not resumed their antihyperglycemic agents at discharge also were more likely to be discharged without receiving statins, β-blockers, ACE inhibitors, and aspirin.
The study is limited by the lack of data regarding changes in patients' prescriptions after discharge. It is unclear if patients immediately visited their primary care doctors and resumed their antihyperglycemic medications.
Dr. Inzucchi said that cardiologists need to address diabetes during discharge planning, even if it's simply to have patients follow up with their primary doctors.
“It's your gold check-off box,” he stressed. “What are we going to do about the diabetes?”