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Standard cardiac rehabilitation is less effective for diabetics
V Suresh1, R A Harrison, P Houghton
1Department of Cardiology, Wigan and Leigh NHS Trust Wigan, Wigan Lane, Wigan, Lancs WN1 2NN, UK.
Insights
Diabetic patients experienced poorer outcomes in standard cardiac rehabilitation programs after myocardial infarction (MI). These patients had less medication, lower smoking cessation rates, and higher mortality, suggesting a need for specialized programs.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Myocardial infarction (MI) is a leading cause of mortality globally.
- Cardiac rehabilitation (CR) improves outcomes for post-MI patients.
- Diabetes mellitus is a significant risk factor for cardiovascular disease and impacts CR effectiveness.
Purpose of the Study:
- To evaluate clinical outcomes and lifestyle modifications in diabetic patients undergoing standard CR post-MI.
- To compare the effectiveness of standard CR for diabetic versus non-diabetic patients.
- To identify specific areas where standard CR falls short for diabetic individuals.
Main Methods:
- Retrospective longitudinal study design.
- Analysis of data from 1804 patients (223 with diabetes) attending CR over 10 years.
- Comparison of medication adherence, lifestyle modifications (smoking cessation, physiotherapy), and mortality rates between diabetic and non-diabetic groups.
Main Results:
- Diabetic patients received significantly less aspirin and beta-blocker therapy (p < 0.0001).
- Smoking cessation rates were lower (54.2% vs 69.1%, p < 0.003) and physiotherapy attendance was reduced (26.9% vs 58.6%, p < 0.0001) in diabetics.
- Diabetic patients exhibited higher one-year mortality (15.7% vs 5.6%, p < 0.0001), primarily due to cardiovascular disease.
Conclusions:
- Standard CR programs are less effective for patients with diabetes mellitus.
- Specialized rehabilitation programs are needed to integrate chronic condition management with MI care.
- Aggressive, evidence-based pharmacotherapy should be prioritized for all post-MI patients, including those with diabetes.
Abstract:
To assess clinical outcomes and lifestyle modifications in diabetic patients attending a standard cardiac rehabilitation programme following myocardial infarction (MI), a retrospective longitudinal study was undertaken in a district general hospital in the north west of England. A total of 1804 patients attended the cardiac rehabilitation programme over 10 years, of whom 223 (12.4%) had diabetes mellitus. Drugs were underprescribed in all patients, aspirin and beta-blockers especially in diabetics (75.3% vs 90.3%, p < 0.0001; 38.6% vs 60.8%, p < 0.0001). Smoking cessation was poor in diabetics (54.2% vs 69.1%, p < 0.003) and diabetics were less likely to attend at least one session of physiotherapy (26.9% vs 58.6%, p < 0.0001). Diabetics had higher mortality at one year (15.7% vs 5.6%; p < 0.0001), mostly associated with cardiovascular disease (13.4% vs 5.4%, p < 0.0001). Standard cardiac rehabilitation programmes appear to be less effective for patients with diabetes mellitus. We suggest that patients presenting with an existing chronic condition need specialised programmes of rehabilitation to integrate the care of that condition with their recent MI. Aggressive drug therapy following acute MI should also be prescribed in all patients when not contraindicated by other evidence.