ACUTE myocardial infarction (AMI) is the foremost cause of global mortality, with non-ST segment myocardial infarction (NSTEMI) incidents particularly rising. Diabetes mellitus significantly increases the risk of NSTEMI, affecting nearly 25–30% of these patients. The prognosis of AMI is notably poorer for those with diabetes, as they face a 50% higher risk of long-term mortality compared to non-diabetic individuals. This discrepancy emphasises the need for targeted medical approaches within this vulnerable population.
Recent advancements in diabetes care, such as improved glycaemic monitoring, have positively impacted blood glucose control, reducing mortality risks and enhancing cardiovascular outcomes. Although historical evidence suggests that these interventions may improve AMI survival rates, disparities in NSTEMI care among diabetics persist. Research has shown that people with diabetes tend to receive less in-hospital care than non-diabetics, despite experiencing higher rates of adverse outcomes.
A recent study utilised data from the Myocardial Ischaemia National Audit Project (MINAP) to evaluate the in-hospital quality of care for diabetics with NSTEMI. The analysis of over 450,000 NSTEMI admissions revealed disparities in both care and long-term outcomes. Diabetic patients were less likely to undergo invasive investigations like coronary angiography but were more likely to receive medications like statins, beta-blockers, and ACE inhibitors. This trend highlights a risk-treatment paradox where high-risk patients often receive less aggressive treatments due to concerns over complications.
Notably, diabetics admitted with NSTEMI had worse short-term and long-term mortality outcomes compared to non-diabetics. Those who received high-quality, guideline-recommended care saw better long-term survival, however, barriers persist, including limited access to specialist cardiology wards, which provide essential care that can significantly improve outcomes. Diabetic individuals also faced delays in invasive procedures, contrary to clinical guidelines recommending early intervention.
This research underscores the need for equitable, guideline-driven NSTEMI care across diabetic and non-diabetic populations. By addressing these disparities, healthcare providers can better support diabetic individuals post-AMI, potentially improving their long-term survival.
Katie Wright, EMJ
Reference
Cole A et al. Addressing disparities in the long-term mortality risk in individuals with non-ST segment myocardial infarction (NSTEMI) by diabetes mellitus status: a nationwide cohort study. Diabetologia. 2024;DOI:10.1007/s00125-024-06281-7.
