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Published in: BMC Cardiovascular Disorders 1/2006

Open Access 01-12-2006 | Research article

The impact of diabetes on one-year health status outcomes following acute coronary syndromes

Authors: Pamela N Peterson, John A Spertus, David J Magid, Fredrick A Masoudi, Kimberly Reid, Richard F Hamman, John S Rumsfeld

Published in: BMC Cardiovascular Disorders | Issue 1/2006

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Abstract

Background

Diabetes is an important predictor of mortality patients with ACS. However, little is known about the association between diabetes and health status after ACS. The objective of this study was to examine the association between diabetes and patients' health status outcomes one year after an acute coronary syndrome (ACS).

Methods

This was a prospective cohort study of patients hospitalized with ACS. Patients were evaluated at baseline and one year with the Seattle Angina Questionnaire (SAQ). Socio-demographic and clinical characteristics were ascertained during index ACS hospitalization. One year SAQ Angina Frequency, Physical Limitation, and Health-Related Quality of Life (HRQoL) scales were the primary outcomes of the study.

Results

Of 1199 patients, 326 (37%) had diabetes. Patients with diabetes were more likely to present with unstable angina (52% vs. 40%; p < 0.001), less likely to present with STEMI (20% vs. 31%; p < 0.001), and less likely to undergo coronary angiography (68% vs. 82%; p < 0.001). In multivariable analyses, the presence of diabetes was associated with significantly more angina (OR 1.36; 95% CI 1.01–1.38), cardiac-related physical limitation (OR 1.94; 95% CI 1.57–3.24) and HRQoL deficits (OR 1.43; 95% CI 1.01–2.04) at one year.

Conclusion

Diabetes is associated with more angina, worse physical limitation, and worse HRQoL one year after an ACS. Future studies should assess whether health status outcomes of patients with diabetes could be improved through more aggressive ACS treatment or post-discharge surveillance and angina management.
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Literature
1.
go back to reference Association AH: Heart Disease and Stroke Statistics - 2004 Update. 2003, Dallas, TX, American Heart Association Association AH: Heart Disease and Stroke Statistics - 2004 Update. 2003, Dallas, TX, American Heart Association
2.
go back to reference Spertus JA, Jones P, McDonell M, Fan V, Fihn SD: Health status predicts long-term outcome in outpatients with coronary disease. Circulation. 2002, 106: 43-49. 10.1161/01.CIR.0000020688.24874.90.CrossRefPubMed Spertus JA, Jones P, McDonell M, Fan V, Fihn SD: Health status predicts long-term outcome in outpatients with coronary disease. Circulation. 2002, 106: 43-49. 10.1161/01.CIR.0000020688.24874.90.CrossRefPubMed
3.
go back to reference Mozaffarian D, Bryson CL, Spertus JA, McDonell MB, Fihn SD: Anginal symptoms consistently predict total mortality among outpatients with coronary artery disease. American Heart Journal. 2003, 146: 1015-1022. 10.1016/S0002-8703(03)00436-8.CrossRefPubMed Mozaffarian D, Bryson CL, Spertus JA, McDonell MB, Fihn SD: Anginal symptoms consistently predict total mortality among outpatients with coronary artery disease. American Heart Journal. 2003, 146: 1015-1022. 10.1016/S0002-8703(03)00436-8.CrossRefPubMed
4.
go back to reference Soto GE, Jones P, Weintraub WS, Krumholz HM, Spertus JA: Prognostic Value of Health Status in Patients With Heart Failure After Acute Myocardial Infarction. Circulation. 2004, 110: 546-551. 10.1161/01.CIR.0000136991.85540.A9.CrossRefPubMed Soto GE, Jones P, Weintraub WS, Krumholz HM, Spertus JA: Prognostic Value of Health Status in Patients With Heart Failure After Acute Myocardial Infarction. Circulation. 2004, 110: 546-551. 10.1161/01.CIR.0000136991.85540.A9.CrossRefPubMed
5.
go back to reference Nesto RW, Phillips RT: Asymptomatic myocardial ischemia in diabetic patients. American Journal of Medicine. 1986, 80: 40-7. 10.1016/0002-9343(86)90451-1.CrossRefPubMed Nesto RW, Phillips RT: Asymptomatic myocardial ischemia in diabetic patients. American Journal of Medicine. 1986, 80: 40-7. 10.1016/0002-9343(86)90451-1.CrossRefPubMed
6.
go back to reference Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. New England Journal of Medicine. 1996, 335: 217-225. 10.1056/NEJM199607253350401. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. New England Journal of Medicine. 1996, 335: 217-225. 10.1056/NEJM199607253350401.
7.
go back to reference Brown DW, Balluz LS, Giles WH, Beckles GL, Boriarty DG, Ford ES, Mokdad AH: Diabetes mellitus and helath-related quality of life among older adults. Findings from the behaviora risk factor surveillance system (BRFSS). Diabetes Research & Clinical Practice. 2004, 65: 105-115. 10.1016/j.diabres.2003.11.014.CrossRef Brown DW, Balluz LS, Giles WH, Beckles GL, Boriarty DG, Ford ES, Mokdad AH: Diabetes mellitus and helath-related quality of life among older adults. Findings from the behaviora risk factor surveillance system (BRFSS). Diabetes Research & Clinical Practice. 2004, 65: 105-115. 10.1016/j.diabres.2003.11.014.CrossRef
8.
go back to reference Hanninen J, Takala J, Keinanen-Kiukaanniemi S: Quality of life in NIDDM patients assessed with the SF-20 questionnaire. Diabetes Research & Clinical Practice. 1998, 42: 17-27. 10.1016/S0168-8227(98)00085-0.CrossRef Hanninen J, Takala J, Keinanen-Kiukaanniemi S: Quality of life in NIDDM patients assessed with the SF-20 questionnaire. Diabetes Research & Clinical Practice. 1998, 42: 17-27. 10.1016/S0168-8227(98)00085-0.CrossRef
9.
go back to reference Alpert JS, Thygesen K, Antman E, Bassand JP: Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Journal of the American College of Cardiology. 2000, 36: 959-969. 10.1016/S0735-1097(00)00804-4.CrossRefPubMed Alpert JS, Thygesen K, Antman E, Bassand JP: Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Journal of the American College of Cardiology. 2000, 36: 959-969. 10.1016/S0735-1097(00)00804-4.CrossRefPubMed
11.
go back to reference Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD: Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. Journal of the American College of Cardiology. 1995, 25: 333-341. 10.1016/0735-1097(94)00397-9.CrossRefPubMed Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD: Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. Journal of the American College of Cardiology. 1995, 25: 333-341. 10.1016/0735-1097(94)00397-9.CrossRefPubMed
12.
go back to reference Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Fihn SD: Monitoring the quality of life in patients with coronary artery disease. American Journal of Cardiology. 1994, 74: 1240-1244. 10.1016/0002-9149(94)90555-X.CrossRefPubMed Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Fihn SD: Monitoring the quality of life in patients with coronary artery disease. American Journal of Cardiology. 1994, 74: 1240-1244. 10.1016/0002-9149(94)90555-X.CrossRefPubMed
13.
14.
go back to reference Fairclough DL: Interdisciplinary Statistics. Design and Analysis of Quality of Life Studies in Clinical Trials. Edited by: Keiding N. 2002, Boca Raton, Chapman & Hall/CRC, 69-90. Fairclough DL: Interdisciplinary Statistics. Design and Analysis of Quality of Life Studies in Clinical Trials. Edited by: Keiding N. 2002, Boca Raton, Chapman & Hall/CRC, 69-90.
15.
go back to reference Ditchburn CJ, Hall JA, de Belder M, Davies A, Kelly W, Bilous R: Silent myocardial ischaemia in patients with proved coronary artery disease: a comparison of diabetic and non-diabetic patients. Postgraduate Medical Journal. 2001, 77: 395-398. 10.1136/pmj.77.908.395.CrossRefPubMedPubMedCentral Ditchburn CJ, Hall JA, de Belder M, Davies A, Kelly W, Bilous R: Silent myocardial ischaemia in patients with proved coronary artery disease: a comparison of diabetic and non-diabetic patients. Postgraduate Medical Journal. 2001, 77: 395-398. 10.1136/pmj.77.908.395.CrossRefPubMedPubMedCentral
17.
go back to reference Parmley WW: Prevalence and clinical significance of silent myocardial ischemia. Circulation. 1989, 80: IV68-73.PubMed Parmley WW: Prevalence and clinical significance of silent myocardial ischemia. Circulation. 1989, 80: IV68-73.PubMed
18.
go back to reference Caracciolo EA, Chaitman BR, Forman SA, Stone PH, Bourassa MG, Sopko G, Geller NL, Conti CR: Diabetics with coronary disease have a prevalence of asymptomatic ischemia during exercise treadmill testing and ambulatory ischemia monitoring similar to that of nondiabetic patients. An ACIP database study. ACIP Investigators. Asymptomatic Cardiac Ischemia Pilot Investigators. Circulation. 1996, 93: 2097-2105.CrossRefPubMed Caracciolo EA, Chaitman BR, Forman SA, Stone PH, Bourassa MG, Sopko G, Geller NL, Conti CR: Diabetics with coronary disease have a prevalence of asymptomatic ischemia during exercise treadmill testing and ambulatory ischemia monitoring similar to that of nondiabetic patients. An ACIP database study. ACIP Investigators. Asymptomatic Cardiac Ischemia Pilot Investigators. Circulation. 1996, 93: 2097-2105.CrossRefPubMed
19.
go back to reference Callaham PR, Froelicher VF, Klein J, Risch M, Dubach P, Friis R: Exercise-induced silent ischemia: age, diabetes mellitus, previous myocardial infarction and prognosis. Journal of the American College of Cardiology. 1989, 14: 1175-1180. 10.1016/0735-1097(89)90413-0.CrossRefPubMed Callaham PR, Froelicher VF, Klein J, Risch M, Dubach P, Friis R: Exercise-induced silent ischemia: age, diabetes mellitus, previous myocardial infarction and prognosis. Journal of the American College of Cardiology. 1989, 14: 1175-1180. 10.1016/0735-1097(89)90413-0.CrossRefPubMed
20.
go back to reference Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA: Health-Related Quality of Life After Interventional or Conservative Strategy in Patients With Unstable Angina or Non-ST-Segment Elevation Myocardial Infarction. One-Year Results of the Third Randomized Intervention Trial of Unstable Angina (RITA-3). Journal of the American College of Cardiology. 2005, 45: 221-228. 10.1016/j.jacc.2004.10.034.CrossRefPubMed Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA: Health-Related Quality of Life After Interventional or Conservative Strategy in Patients With Unstable Angina or Non-ST-Segment Elevation Myocardial Infarction. One-Year Results of the Third Randomized Intervention Trial of Unstable Angina (RITA-3). Journal of the American College of Cardiology. 2005, 45: 221-228. 10.1016/j.jacc.2004.10.034.CrossRefPubMed
21.
go back to reference Dougherty CM, Dewhurst T, Nichol WP, Spertus J: Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index-Cardiac Version III. Journal of Clinical Epidemiology. 1998, 51: 569-75. 10.1016/S0895-4356(98)00028-6.CrossRefPubMed Dougherty CM, Dewhurst T, Nichol WP, Spertus J: Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index-Cardiac Version III. Journal of Clinical Epidemiology. 1998, 51: 569-75. 10.1016/S0895-4356(98)00028-6.CrossRefPubMed
22.
go back to reference Beinart SC, Sales AE, Spertus JA, Plomondon ME, Every NR, Rumsfeld JS: Impact of angina burden and other factors on treatment satisfaction after acute coronary syndromes. American Heart Journal. 2003, 146: 646-52. 10.1016/S0002-8703(03)00256-4.CrossRefPubMed Beinart SC, Sales AE, Spertus JA, Plomondon ME, Every NR, Rumsfeld JS: Impact of angina burden and other factors on treatment satisfaction after acute coronary syndromes. American Heart Journal. 2003, 146: 646-52. 10.1016/S0002-8703(03)00256-4.CrossRefPubMed
23.
go back to reference Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TBJ, Fihn SD, Fraker TDJ, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SCJ, Cardiology AC, American Heart Association Task Force on Practice Guidelines.Committee on the Management of Patients With Chronic Stable Angina: ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003, 107: 149-58. 10.1161/01.CIR.0000047041.66447.29.CrossRefPubMed Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TBJ, Fihn SD, Fraker TDJ, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SCJ, Cardiology AC, American Heart Association Task Force on Practice Guidelines.Committee on the Management of Patients With Chronic Stable Angina: ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003, 107: 149-58. 10.1161/01.CIR.0000047041.66447.29.CrossRefPubMed
24.
go back to reference Wiest FC, Bryson CL, Burman M, McDonell MB, Henikoff JG, Fihn SD: Suboptimal pharmacotherapeutic management of chronic stable angina in the primary care setting. American Journal of Medicine. 2004, 117: 234-241. 10.1016/j.amjmed.2004.02.044.CrossRefPubMed Wiest FC, Bryson CL, Burman M, McDonell MB, Henikoff JG, Fihn SD: Suboptimal pharmacotherapeutic management of chronic stable angina in the primary care setting. American Journal of Medicine. 2004, 117: 234-241. 10.1016/j.amjmed.2004.02.044.CrossRefPubMed
25.
go back to reference Beaulieu MD, Blais R, Jacques A, Battista RN, Lebeau R, Brophy J: Are patients suffering from stable angina receiving optimal medical treatment?. Qjm. 2001, 94: 301-308. 10.1093/qjmed/94.6.301.CrossRefPubMed Beaulieu MD, Blais R, Jacques A, Battista RN, Lebeau R, Brophy J: Are patients suffering from stable angina receiving optimal medical treatment?. Qjm. 2001, 94: 301-308. 10.1093/qjmed/94.6.301.CrossRefPubMed
26.
go back to reference Pepine CJ: Angina Pectoris in a Contemporary Population: Characteristics and Therapeutic Implications. Cardiovascular Drugs and Therapy. 1998, 12: 211-216. 10.1023/A:1017193011667.CrossRefPubMed Pepine CJ: Angina Pectoris in a Contemporary Population: Characteristics and Therapeutic Implications. Cardiovascular Drugs and Therapy. 1998, 12: 211-216. 10.1023/A:1017193011667.CrossRefPubMed
27.
go back to reference Carasso S, Markiewicz W: Medical treatment of patients with stable angina pectoris referred for coronary angiography: failure of treatment or failure to treat. Clinical Cardiology. 2002, 25: 436-41.CrossRefPubMed Carasso S, Markiewicz W: Medical treatment of patients with stable angina pectoris referred for coronary angiography: failure of treatment or failure to treat. Clinical Cardiology. 2002, 25: 436-41.CrossRefPubMed
28.
go back to reference Seki E, Watanabe Y, Sunayama S, Iwama Y, Shimada K, Kawakami K, Sato M, Sato H, Mokuno H, Daida H: Effects of phase III cardiac rehabilitation programs on health-related quality of life in elderly patients with coronary artery disease: Juntendo Cardiac Rehabilitation Program (J-CARP). Circulation Journal. 2003, 67: 73-77. 10.1253/circj.67.73.CrossRefPubMed Seki E, Watanabe Y, Sunayama S, Iwama Y, Shimada K, Kawakami K, Sato M, Sato H, Mokuno H, Daida H: Effects of phase III cardiac rehabilitation programs on health-related quality of life in elderly patients with coronary artery disease: Juntendo Cardiac Rehabilitation Program (J-CARP). Circulation Journal. 2003, 67: 73-77. 10.1253/circj.67.73.CrossRefPubMed
29.
go back to reference Pasquali SK, Alexander KP, Coombs LP, Lytle BL, Peterson ED: Effect of cardiac rehabilitation on functional outcomes after coronary revascularization. American Heart Journal. 2003, 145: 445-451. 10.1067/mhj.2003.172.CrossRefPubMed Pasquali SK, Alexander KP, Coombs LP, Lytle BL, Peterson ED: Effect of cardiac rehabilitation on functional outcomes after coronary revascularization. American Heart Journal. 2003, 145: 445-451. 10.1067/mhj.2003.172.CrossRefPubMed
30.
go back to reference Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al: ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Summary Article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation. 2002, 106: 1893-1900. 10.1161/01.CIR.0000037106.76139.53.CrossRefPubMed Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al: ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Summary Article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation. 2002, 106: 1893-1900. 10.1161/01.CIR.0000037106.76139.53.CrossRefPubMed
31.
go back to reference Rumsfeld JS, Magid DJ, Plomondon ME, Sacks J, Henderson W, Hlatky M, Sethi G, Morrison DA, Department of Veterans Affairs Angina With Extremely Serious Operative Mortality (AWESOME) Investigators.: Health-related quality of life after percutaneous coronary intervention versus coronary bypass surgery in high-risk patients with medically refractory ischemia. Journal of the American College of Cardiology. 2003, 41: 1732-1738. 10.1016/S0735-1097(03)00330-9.CrossRefPubMed Rumsfeld JS, Magid DJ, Plomondon ME, Sacks J, Henderson W, Hlatky M, Sethi G, Morrison DA, Department of Veterans Affairs Angina With Extremely Serious Operative Mortality (AWESOME) Investigators.: Health-related quality of life after percutaneous coronary intervention versus coronary bypass surgery in high-risk patients with medically refractory ischemia. Journal of the American College of Cardiology. 2003, 41: 1732-1738. 10.1016/S0735-1097(03)00330-9.CrossRefPubMed
32.
go back to reference Herlitz J, Caidahl K, Wiklund I, Sjoland H, Karlson BW, Karlsson T, Haglid M, Hartford M: Impact of a history of diabetes on the improvement of symptoms and quality of life during 5 years after coronary artery bypass grafting. Journal of Diabetes & its Complications. 2000, 14: 314-321. 10.1016/S1056-8727(00)00115-X.CrossRef Herlitz J, Caidahl K, Wiklund I, Sjoland H, Karlson BW, Karlsson T, Haglid M, Hartford M: Impact of a history of diabetes on the improvement of symptoms and quality of life during 5 years after coronary artery bypass grafting. Journal of Diabetes & its Complications. 2000, 14: 314-321. 10.1016/S1056-8727(00)00115-X.CrossRef
33.
go back to reference Rumsfeld JS, Magid DJ, Plomondon ME, O'Brien MM, Spertus JA, Every NR, Sales AE: Predictors of quality of life following acute coronary syndromes. American Journal of Cardiology. 2001, 88: 781-784. 10.1016/S0002-9149(01)01852-5.CrossRefPubMed Rumsfeld JS, Magid DJ, Plomondon ME, O'Brien MM, Spertus JA, Every NR, Sales AE: Predictors of quality of life following acute coronary syndromes. American Journal of Cardiology. 2001, 88: 781-784. 10.1016/S0002-9149(01)01852-5.CrossRefPubMed
34.
go back to reference Beck CA, Joseph L, Belisle P, Pilote L, QOLAMI Investigators (Quality of life in acute myocardial infarction): Predictors of quality of life 6 months and 1 year after acute myocardial infarction. American Heart Journal. 2001, 142: 271-279. 10.1067/mhj.2001.116758.CrossRefPubMed Beck CA, Joseph L, Belisle P, Pilote L, QOLAMI Investigators (Quality of life in acute myocardial infarction): Predictors of quality of life 6 months and 1 year after acute myocardial infarction. American Heart Journal. 2001, 142: 271-279. 10.1067/mhj.2001.116758.CrossRefPubMed
Metadata
Title
The impact of diabetes on one-year health status outcomes following acute coronary syndromes
Authors
Pamela N Peterson
John A Spertus
David J Magid
Fredrick A Masoudi
Kimberly Reid
Richard F Hamman
John S Rumsfeld
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2006
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-6-41

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