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Management of patients with diabetes after heart attack: a population-based study of 1982 patients from a heart disease register.

BACKGROUND
Previous studies examining the management of patients with diabetes after acute myocardial infarction (AMI) have been based on clinical studies under experimental conditions. We used data from a population-based heart disease register to document differences in the management after AMI between patients with and without diabetes.


HYPOTHESIS
There were no differences in the prescription rates of aspirin, beta blockers, streptokinase, ACE inhibitors and calcium channel blockers between patients with and without diabetes admitted to hospital with AMI.


METHODS
A retrospective study of 268 patients with, and 1714 patients without, diabetes discharged from hospital with 'definite' AMI between August 1988 and March 1994.


RESULTS
The prescription rates of all five drug classes increased between 1988 and 1994 both for patients with and without diabetes. Patients with diabetes were significantly less likely to have been prescribed aspirin (76% vs 85%), beta blockers (41% vs 53%) and streptokinase (25% vs 43%) but more likely to have been prescribed ACE inhibitors (47% vs 29%) and calcium channel blockers (50% vs 40%). The differences in prescription rates were statistically significant after controlling for age, sex, history of ischaemic heart disease, smoking status, educational level and disease severity.


CONCLUSION
Patients with diabetes were less likely to have been prescribed three of the five drug classes where evidence points to a beneficial effect after AMI. Further work is needed to identify the reasons for the disparity between management of patients with and without diabetes, and to develop effective strategies to increase the implementation of best practice guidelines in the management of patients with diabetes after AMI.