Nationwide Study on Trends in Hospital Admissions for Major Cardiovascular Events and Procedures Among People With and Without Diabetes in England, 2004–2009

Abstract

OBJECTIVEIt is unclear whether people with and without diabetes equally benefitted from reductions in cardiovascular disease (CVD). We aimed to compare recent trends in hospital admission rates for angina, acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) among people with and without diabetes in England.RESEARCH DESIGN AND METHODSWe identified all patients aged >16 years with cardiovascular events in England between 2004–2005 and 2009–2010 using national hospital activity data. Diabetes- and nondiabetes-specific rates were calculated for each year. To test for time trend, we fitted Poisson regression models.RESULTSIn people with diabetes, admission rates for angina, AMI, and CABG decreased significantly by 5% (rate ratio 0.95 [95% CI 0.94–0.96]), 5% (0.95 [0.93–0.97]), and 3% (0.97 [0.95–0.98]) per year, respectively. Admission rates for stroke did not significantly change (0.99 [0.98–1.004]) but increased for PCI (1.01 [1.005–1.03]) in people with diabetes. People with and without diabetes experienced similar proportional changes for all outcomes, with no significant differences in trends between these groups. However, diabetes was associated with an ~3.5- to 5-fold risk of CVD events. In-hospital mortality rates declined for AMI and stroke, remained unchanged for CABG, and increased for PCI admissions in both groups.CONCLUSIONSThis national study suggests similar changes in admissions for CVD in people with and without diabetes. Aggressive risk reduction is needed to further reduce the high absolute and relative risk of CVD still present in people with diabetes.

Using Large Diabetes Databases for Research

“…Validation suggests that completeness based on these criteria is ≥95%, although date of diagnosis of diabetes may be unreliable and there may be overestimation of the number of people with diabetes from glucose measurement alone. 15 Some studies use coding of diabetes in hospital records to identify people with diabetes (for example) 16 and the completeness of this approach can be expected to vary depending on choice of codes, outcome of interest and hospital. 12 When using International Classification of Disease codes it is important to be aware of changes in coding rules between different revisions.…”

Acute coronary syndrome – the present and future role of biomarkers1)

“…The incidence of ACS is declining in most developed countries [3,4]. Lifestyle adjustments in the general population, e.g., reduction in smoking and of serum cholesterol levels, have contributed to the reduction in incidence [5].…”

Total/high density lipoprotein cholesterol and cardiovascular disease (re)hospitalization nadir in type 2 diabetes

“…In some locations and age groups, it is as many as one in five (3). The associated costs of excess admissions, as well as increased costs per admission, are significant contributors to the financial burden borne by healthcare systems from diabetes and often reflect preventable morbidity suffered by patients (4).…”

“…Both total and low density lipoprotein (LDL) cholesterol have been found to correlate with risk of CHD consistently over different studies (5). Among various lipid profile measurements, the total cholesterol to high density lipoprotein cholesterol ratio (TC/HDL) has been widely used as a prognostic factor to predict the risk of CVD both in general (3) and diabetes populations, as applied in the UKPDS score reflecting its association both with CHD (6) and stroke in people with type 2 diabetes.…”

“…CVD hospitalisation and re-hospitalisation are important components of the increased costs of diabetes and the preventable morbidity suffered by people with diabetes (6).…”