Diabetics More Likely To Die After Heart Attack

Mortality is still higher in those with diabetes than in non-diabetics, even though the treatment of people with diabetes who suffer a heart attack has improved.

Dr. Anna Norhammar, of the Karolinska Institute, Stockholm, Sweden, and colleagues assessed death rates and treatment patterns in 1995-1998 and 1999-2002 in 70,882 people younger than age 80 years — 14,873 of whom had diabetes.
They report, in the medical journal Heart, that patients with diabetes have higher short- and long-term mortality rates after heart attack than those without diabetes.

"This pattern has remained even after the introduction of modern therapeutic principles," they write.

Specifically, the data show a decrease in the 1-year mortality rate from 1995 to 2002 from 16.6 percent to 12.1 percent in non-diabetic patients. In diabetic patients, 1-year mortality rates decreased from 29.7 percent to 19.7 percent.

Nonetheless, diabetic heart attack patients were more likely to die than non-diabetic attack patients. Diabetics had an adjusted relative 1-year mortality risk of 1.44 in 1995-1998 and 1.31 in 1999-2002.

Despite improvements in pre-admission and in-hospital treatment, patients with diabetes were less likely to receive immediate clot-busting therapy and revascularization procedures. Diabetic patients also less often received aspirin and lipid-lowering treatment at discharge.

Norhammar’s team concluded that, there are "ample opportunities for further improvements in the care of diabetic patients" who suffer heart attack.

While underlying co-illnesses in part account for the excess mortality in patients with diabetes, it can also be attributed to "a less than optimal use of established treatment modalities, especially lipid-lowering therapy and early revascularization."
Heart, December 2007.