By following guidelines, hospital mortality in clinical practice reduced by 36% between 1994 and 2002
Diabetes mellitus increases the risk to develop coronary artery disease by the factor two to four. Cardiovascular complications are the leading causes of morbidity and mortality in patients with diabetes.
In randomized controlled trials as well as in prospective registries, diabetics with acute ST-elevation myocardial infarction (STEMI) have been identified to be a high risk population with a significantly increased hospital mortality as compared to non-diabetics.
Since 1994 prospective multicenter registries of acute STEMI have been conducted in Germany (MITRA PLUS: 319 hospitals) to document patient characteristics, acute treatment and hospital outcome in clinical practice.
To close the circle between existing guidelines and clinical practice all registries used regular benchmarking reports to give feedback to the participating centers for quality control. Acute reperfusion and adjunctive treatment of STEMI as well as hospital mortality in diabetics were analyzed using 2-year periods to verify, if better adherence to existing guidelines for the treatment of STEMI improved hospital outcome in diabetics. Between 1994 and 2002 a total of 35,153 consecutive patients with acute STEMI had been enrolled into MITRA PLUS of whom 8516 (24%) had known diabetes. Acute reperfusion therapy increased from 47% to 65% with a more frequent use of primary PCI replacing thrombolysis. In addition, adjunctive treatment with betablockers, ACE-inhibitors and statins was improved within the years.
Associated with the improvement of acute reperfusion and adjunctive treatment of STEMI in diabetics in clinical practice according to existing guidelines a significant reduction of hospital mortality from initially 20.5% in 1994/96 to 13.2% in 2001/02 was observed.
Between 1994 and 2002 the acute treatment of STEMI in diabetics in Germany significantly improved according to existing guidelines. This improvement in acute treatment was associated with a 36% relative reduction in hospital mortality for diabetics with STEMI.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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