CARDIOVASCULAR RISK AND UPTAKE OF EVIDENCE-BASED THERAPIES IN PATIENTS WITH TYPE 2 DIABETES AFTER AN ACUTE CARDIOVASCULAR EVENT: INSIGHTS FROM THE CANHEART REGISTRY

Abstract

BACKGROUND Numerous type 2 diabetes (T2DM) therapies that improve cardiovascular (CV) outcomes are now available; however, there is limited data on their utilization following an acute CV event. This study characterized the association between T2DM and adverse CV events following a hospital admission for a major CV event and identified high-risk patient subgroups who could benefit from further CV risk reduction with such therapies. METHODS AND RESULTS We conducted a population-based retrospective study using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) registry of health services databases in the province of Ontario, Canada. These datasets were linked using unique encoded identifiers and analyzed at ICES. Patients were eligible if they were ≥18 years of age and discharged alive from hospital between June 1, 2015 and March 31, 2019 with a diagnosis of a major adverse CV event (defined as acute myocardial infarction [AMI], hospitalization for heart failure [HHF], ischemic stroke, or peripheral arterial disease [PAD]). The main exposure was the presence of T2DM at the time of index hospitalization. Multivariate Cox models were adjusted for baseline sociodemographic and clinical comorbidities to estimate hazard ratios (HR) associated between T2DM and the primary outcome (a composite of all-cause death or recurrent AMI, HHF, ischemic stroke, or PAD). Among the subset of patients ≥66 years of age who were eligible for universal drug coverage, prescription patterns were determined following discharge. The cohort comprised 157,640 patients (T2DM: N=67,083; 42.6%; median age 72 years). After a median of 2 years of follow up, the primary outcome occurred in 30,939 (46.1%) patients with T2DM compared to 29,097 (32.1%) patients without T2DM (adjusted HR 1.28, 95% CI, 1.26-1.30, p < 0.0001). The presence of T2DM accounted for the greatest increase in risk in the primary endpoint in patients admitted for PAD, followed by AMI, ischemic stroke, and HHF respectively (Figure). In T2DM patients ≥66 years of age, uptake of guideline-directed medical therapy increased from 100 days prior to hospitalization to 2 years of follow-up: ACEi/ARB (66.0% to 75.6%), statin (64.8% to 82.7%), SGLT2i (4.7% to 15.3%), GLP1-RA (previously not covered to 2.3%). CONCLUSION Patients with T2DM admitted for a major CV event have an adjusted 28% higher risk of all-cause death or recurrent CV event compared with patients without diabetes. This population is at high risk for recurrent events and would benefit from higher implementation of evidence-based diabetes therapies with demonstrated CV protection. Numerous type 2 diabetes (T2DM) therapies that improve cardiovascular (CV) outcomes are now available; however, there is limited data on their utilization following an acute CV event. This study characterized the association between T2DM and adverse CV events following a hospital admission for a major CV event and identified high-risk patient subgroups who could benefit from further CV risk reduction with such therapies. We conducted a population-based retrospective study using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) registry of health services databases in the province of Ontario, Canada. These datasets were linked using unique encoded identifiers and analyzed at ICES. Patients were eligible if they were ≥18 years of age and discharged alive from hospital between June 1, 2015 and March 31, 2019 with a diagnosis of a major adverse CV event (defined as acute myocardial infarction [AMI], hospitalization for heart failure [HHF], ischemic stroke, or peripheral arterial disease [PAD]). The main exposure was the presence of T2DM at the time of index hospitalization. Multivariate Cox models were adjusted for baseline sociodemographic and clinical comorbidities to estimate hazard ratios (HR) associated between T2DM and the primary outcome (a composite of all-cause death or recurrent AMI, HHF, ischemic stroke, or PAD). Among the subset of patients ≥66 years of age who were eligible for universal drug coverage, prescription patterns were determined following discharge. The cohort comprised 157,640 patients (T2DM: N=67,083; 42.6%; median age 72 years). After a median of 2 years of follow up, the primary outcome occurred in 30,939 (46.1%) patients with T2DM compared to 29,097 (32.1%) patients without T2DM (adjusted HR 1.28, 95% CI, 1.26-1.30, p < 0.0001). The presence of T2DM accounted for the greatest increase in risk in the primary endpoint in patients admitted for PAD, followed by AMI, ischemic stroke, and HHF respectively (Figure). In T2DM patients ≥66 years of age, uptake of guideline-directed medical therapy increased from 100 days prior to hospitalization to 2 years of follow-up: ACEi/ARB (66.0% to 75.6%), statin (64.8% to 82.7%), SGLT2i (4.7% to 15.3%), GLP1-RA (previously not covered to 2.3%). Patients with T2DM admitted for a major CV event have an adjusted 28% higher risk of all-cause death or recurrent CV event compared with patients without diabetes. This population is at high risk for recurrent events and would benefit from higher implementation of evidence-based diabetes therapies with demonstrated CV protection.