Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction

Clin Cardiol. 2020 Dec;43(12):1352-1361. doi: 10.1002/clc.23476. Epub 2020 Nov 4.


Background: Diabetes mellitus (DM) is associated with increased cardiovascular (CV) risk. We compared health-related quality of life (HRQoL), healthcare resource utilization (HRU), and clinical outcomes of stable post-myocardial infarction (MI) patients with and without DM.

Hypothesis: In post-MI patients, DM is associated with worse HRQoL, increased HRU, and worse clinical outcomes.

Methods: The prospective, observational long-term risk, clinical management, and healthcare Resource utilization of stable coronary artery disease study obtained data from 8968 patients aged ≥50 years 1 to 3 years post-MI (369 centers; 25 countries). Patients with ≥1 of the following risk factors were included: age ≥65 years, history of a second MI >1 year before enrollment, multivessel coronary artery disease, creatinine clearance ≥15 and <60 mL/min, and DM treated with medication. Self-reported health status was assessed at baseline, 1 and 2 years and converted to EQ-5D scores. The main outcome measures were baseline HRQoL and HRU during follow-up.

Results: DM at enrollment was 33% (2959 patients, 869 insulin treated). Mean baseline EQ-5D score (0.86 vs 0.82; P < .0001) was higher; mean number of hospitalizations (0.38 vs 0.50, P < .0001) and mean length of stay (LoS; 9.3 vs 11.5; P = .001) were lower in patients without vs with DM. All-cause death and the composite of CV death, MI, and stroke were significantly higher in DM patients, with adjusted 2-year rate ratios of 1.43 (P < .01) and 1.55 (P < .001), respectively.

Conclusions: Stable post-MI patients with DM (especially insulin treated) had poorer EQ-5D scores, higher hospitalization rates and LoS, and worse clinical outcomes vs those without DM. Strategies focusing specifically on this high-risk population should be developed to improve outcomes.

Trial registration: ClinicalTrials.gov: NCT01866904 (https://clinicaltrials.gov).

Keywords: cardiovascular events; diabetes; healthcare resource utilization; myocardial infarction; quality of life.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Diabetes Mellitus / economics
  • Diabetes Mellitus / psychology*
  • Female
  • Follow-Up Studies
  • Health Resources / statistics & numerical data*
  • Health Status*
  • Humans
  • Male
  • Myocardial Infarction / economics
  • Myocardial Infarction / psychology*
  • Prognosis
  • Prospective Studies
  • Quality of Life
  • Risk Factors
  • Self Report*
  • Time Factors

Associated data

  • ClinicalTrials.gov/NCT01866904