Abstract 12341: Improvement in Adherence to Guideline Based Therapy in Diabetic Patients Admitted with Acute Coronary Syndrome: Findings from AHA Get With the Guidelines Program

Abstract

Objective: To evaluate and compare characteristics, hospital length of stay, in-hospital mortality and temporal trends in adherence to guideline based therapy at discharge among diabetic (DM) and non diabetic (NDM) patients (pts) admitted with ACS.

Methods: The study population consisted of 151,270 pts admitted with ACS from January 2002 to December 2008 at 411 sites fully participating in the AHA Get With The Guidelines (GWTG) program.

Results: There were 48,938 (32%) pts with DM. DM pts were significantly (p<.0001) older, non-whites with more Hispanics and African Americans. DM pts had more NSTEMIs and longer LOS with higher in-hospital mortality. (Table 1) At discharge, fewer DM pts were on RAAS blocking agents despite greater frequency of LV dysfunction and CKD. There were significant improvements in use of guideline-based therapy from 2002 to 2008 in both pts with and without DM at discharge (Tables 2 and 3). Cochran-Mantel-Haenszel analysis comparing trends in DM with NDM pts showed highly significant (p < 0.0001) differences between the groups with exception of BB, Lipid lowering Rx and Weight management.

Conclusions: There has been significant and continued improvement in most performance measures in ACS pts with and without DM treated at the hospitals participating in GWTG program. However, additional opportunities exist for use of ACEI/ARB and BP control at discharge.