oa Diabetes Mellitus: Unwanted Visitor in the Tertiary Heart Hospitals

Diabetes mellitus (DM) and cardiovascular diseases (CVD) constitute a major health care challenge worldwide. We evaluated the trends and outcome of DM in patients presenting with CVD over a 22-year period in the state of Qatar.

Methods

We performed a descriptive retrospective chart review of all admitted CVD patients, including DM from the Cardiology and Cardiovascular Surgery database at the Heart Hospital (HH) of Hamad Medical Corporation (HMC) in Qatar over a 22-year period.

Results

During the study period between the year 1991 and 2012, a total of 48,803 patients (77% males; 40.3% diabetics) were admitted to the HH, resulting in an average admissions rate of 2218 CVD patients per year. Two out of five CVD patients (40%) were known diabetics. Thus, it was estimated that 14.2 per 10,000 people of the general population in Qatar have both DM and CVD. On average each year, 895 CVD patients admitted to the HH are diabetics. The overall proportion of admissions for diabetic patients with CVD increased over the study duration. Diabetic males were 6 years younger than females. DM was more prevalent in Arabs (68 vs. 32%), but its burden showed a decreasing trend over time compared with South Asians. Diabetics presented with ST-elevation myocardial infarction (47.5 vs. 22.7%), tended to be 8 years younger compared with heart failure with DM. Over the study period, beta-blocker use increased substantially (from 10 to 71%). However, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) were underutilized (from 30 to 56%). There were 4.4 deaths per 100 CVD admissions, which is equivalent to 97 deaths per year. Of this, 52% had DM (2.3 deaths per 100 CVD admissions). The overall case fatality rate (CFR) of DM was 5.6%. Diabetic Asian patients died 9 years earlier than diabetic Arabs at the HH. Age-adjusted Predictors of mortality in DM patients in the HH included lack of beta-blocker use (OR 4.35), lack of ACEI/ARBs use (OR 3.58), myocardial infarction (OR 3.20), lack of aspirin use (OR 2.56), and congestive heart failure (OR 1.75) (P = 0.001 for all).

Conclusions

In Qatar, DM is still a healthcare challenge. Although the admission rate of diabetic patients is increasing at the HH, the mortality rate is decreasing. Evidence-based medication use remains far from the guideline recommendation; however, it shows a substantial improvement. Lack of evidence-based CVD medications in diabetic patients is associated with a significant increase in the mortality in the HH. Efforts should be directed toward public awareness regarding CVD risk factors and DM through education programs and efficient primary and secondary prevention strategies.