Health and Social Services, Service Systems Research Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.
BMC Health Serv Res. 2011 Aug 3;11:180. doi: 10.1186/1472-6963-11-180.
Chronic conditions such as coronary heart disease (CHD) challenge health care to provide systematic and long-lasting disease management. In this study of patients who were revascularized, we examine whether treatment pathways leading to coronary revascularisation differ between patients with and without diabetes.
This retrospective, nationwide register-based study in Finland in 1998-2007 describes temporal trends in the proportions of 1) revascularisations performed at the first treatment period, and 2) suboptimal treatment pathways to revascularisations, i.e. pathways containing several cardiac emergency hospitalisations. Differences between patient groups were examined using a logistic regression model adjusting for age, comorbidity, and region.
Among patients who underwent revascularisation, upward trends were found in the proportions of revascularisations performed during first hospital admission: among men with CHD alone, the percentages were 28% in 1998 and 77% in 2007; among men with insulin-dependent diabetes (IDD) they were 16% vs. 58% for the respective years; and among men with non-insulin dependent diabetes (NIDD) they were 25% vs. 69%, respectively. Among women the percentages were for non-diabetic group 32% vs. 77%; for IDD group 36% vs. 64%; and for NIDD group 33% vs. 73% for the respective years. Patients with diabetes were less likely to undergo revascularisation during the first hospital admission, in 2005-2007, the odds ratio (OR) for IDD among men was 0.52 (95% confidence interval 0.42-0.64) and for NIDD among men it was 0.79 (95% CI 0.73-0.86) compared to patients with CHD alone. The respective ORs among women were 0.59 (95% CI 0.44-0.78), and 0.83 (95% CI 0.74-0.93).
Treatment practices changed substantially during the study period to favour performing revascularisation during the first hospital admission. The large increase in coronary angioplasty operations is likely to be an important factor behind these changes. However, fewer operations are performed during the first CHD hospitalisation of diabetic patients who undergo coronary revascularisation and they experience more often emergency hospital admissions before the operation than patients without diabetes. To avoid adverse cardiac events, more attention is needed in managing diabetic CHD patients' referral pathways to revascularisation.
冠心病等慢性病给医疗保健带来了挑战，需要提供系统的、长期的疾病管理。在这项对接受血运重建的患者的研究中，我们研究了接受血运重建的患者中，是否存在糖尿病患者与非糖尿病患者之间治疗途径的差异。
这是一项在芬兰进行的回顾性全国性基于登记的研究，时间为 1998 年至 2007 年，描述了 1）首次治疗期间进行血运重建的比例，以及 2）血运重建的次优治疗途径（即包含多次心脏急诊住院的途径）的时间趋势。使用调整年龄、合并症和地区的逻辑回归模型来检查患者组之间的差异。
在接受血运重建的患者中，首次住院期间进行血运重建的比例呈上升趋势：单纯冠心病男性患者中，1998 年的比例为 28%，2007 年为 77%；胰岛素依赖型糖尿病（IDD）男性患者中，1998 年的比例为 16%，2007 年为 58%；非胰岛素依赖型糖尿病（NIDD）男性患者中，1998 年的比例为 25%，2007 年为 69%。女性患者中，非糖尿病组分别为 32%和 77%；IDD 组分别为 36%和 64%；NIDD 组分别为 33%和 73%。与单纯冠心病患者相比，糖尿病患者在 2005 年至 2007 年期间，首次住院时接受血运重建的可能性较小，男性 IDD 的优势比（OR）为 0.52（95%置信区间 0.42-0.64），男性 NIDD 的 OR 为 0.79（95%置信区间 0.73-0.86）。女性患者的相应 OR 分别为 0.59（95%置信区间 0.44-0.78）和 0.83（95%置信区间 0.74-0.93）。
在研究期间，治疗实践发生了重大变化，有利于首次住院期间进行血运重建。冠状动脉成形术数量的大量增加可能是这些变化的重要因素。然而，接受冠状动脉血运重建的糖尿病患者在首次冠心病住院期间接受的手术较少，并且在手术前经历紧急住院的次数多于非糖尿病患者。为了避免不良心脏事件，需要更加关注管理糖尿病合并冠心病患者的血运重建转诊途径。
