Abstract 1252: Multidisciplinary Approach for Diabetic Patients With Ischemic Heart Disease
Background: Diabetic (D) patients (pts) admitted for ACS still have a poor outcomes despite improvements in coronary care.
Hypothesis: We assumed that employing more resources into the management and education of (D) pts would have translated into long term benefits after discharge. Therefore we prompted the proposal for the Day-Hospital Ischemia and Diabetes (DID) Pilot Study, a randomized, controlled study to examine the effectiveness of case-managed diabetes care using a multidisciplinary team approach in (D) pts admitted to manage concomitant ACS.
Methods: We enrolled 445 consecutive (D) pts (165 F, 280 M; 66.33±8.9 y) admitted to ICC for ACS from January1st to June 30th 2001. Pts were randomized to multidisciplinary-cardiology/endocrinology-care (DH group) or usual care-cardiology care (control group) at the time of their discharge from the ward. DH pts were scheduled for outpatient visit every six months or more frequently as required by pts’ clinical conditions. Targets of therapy in DH pts were: BP≤130/80mmHg, LDL-C level<100 mg/dl, and HbA1c <7%. Minimum goal of 30 minutes of moderate-intensity aerobic activity 4 times/week was also required. The primary endpoint of the analysis was all cause mortality. Secondary endpoints were: CV mortality, MI, PCI and CABG. All pts were followed-up for 84±7months.
Results: Pts in the control group received less evidence based medications compared with the DH group (at the end of follow-up: aspirin and/or clopidogrel 73,9% vs 56,3% p=0.0114; statins 69,6% vs 40,7% p=0.0259; beta-blockers 78,3% vs 40,7% p=0.0317; and ACE-inhibitors/ARBs 66,7% vs 38,8% p=0.0168). Compared to controls, DH pts showed lower HbA1c (−9,18%; p=0.05), SBP (−11,14%; p=0.0034), DBP (−1,77%; p=0.001), and HR (−6.9%; p=0.0217). The all cause mortality rates were 30,05% and 17,39%, in controls and DH pts, respectively (p=0,0315). The CV mortality, MI, PCI and CABG rates were 22,34% vs 11% (p<0,02); 21,28% vs 2,9% (p=0,0216); 7,71% vs 4,35% (p=0,32); and 0,27% vs 5,8% (p<0,0001) respectively. The risk-adjusted OR for all cause mortality (control group: referent) was 1.20 (95% CI, 1.02–1.93; p=0.02).
Conclusion: Comprehensive education and therapy using a multidisciplinary approach should be utilized in (D) pts with ischemic heart disease