Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2023; 14(7): 1091-1102
Published online Jul 15, 2023. doi: 10.4239/wjd.v14.i7.1091
Long-term quality-of-care score for predicting the occurrence of acute myocardial infarction in patients with type 2 diabetes mellitus
Pi-I Li, How-Ran Guo
Pi-I Li, Department of Family Medicine, Chi Mei Medical Center, Tainan 710, Taiwan
Pi-I Li, Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
How-Ran Guo, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
How-Ran Guo, Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
Author contributions: Li PI and Guo HR conceived and designed the study; Li PI obtained and analyzed the data, and drafted the manuscript; Guo HR supervised the data analysis and helped interpretation of the results; Guo HR edited and revised the manuscript; both authors critically reviewed the manuscript and have approved the final version.
Supported by the Chi-Mei Medical Center, No. CMNCKU10214 and No. CMFHR112027.
Institutional review board statement: The study was reviewed and approved for publication by the institutional review board of the Chi-Mei Medical Center (Approval No. 10207-E01).
Informed consent statement: The medical center removed personal identifying information from the medical records before releasing them and the informed consent was waived by the institutional review board of the Chi Mei Medical Center.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: This study is based in part on the data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The original anonymous dataset is available upon approval of the organization and with a fee.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: How-Ran Guo, ScD, MD, MPH, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No. 138 Sheng-Li Road, Tainan 704, Taiwan. hrguo@mail.ncku.edu.tw
Received: January 10, 2023
Peer-review started: January 10, 2023
First decision: January 31, 2023
Revised: February 20, 2023
Accepted: May 17, 2023
Article in press: May 17, 2023
Published online: July 15, 2023
Abstract
BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death globally, and diabetes mellitus (DM) is a well-established risk factor. Among the risk factors for CVD, DM is a major modifiable factor. In the fatal CVD outcomes, acute myocardial infarction (AMI) is the most common cause of death.

AIM

To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM on the basis of the hypothesis that good quality of care can reduce the risk of AMI in patients with DM.

METHODS

Using Taiwan’s Longitudinal Cohort of Diabetes Patient Database and the medical charts of a medical center, we identified incident patients diagnosed with type 2 DM from 1999 to 2003 and followed them until 2011. We constructed a summary quality-of-care score (with values ranging from 0 to 8) with process indicators (frequencies of HbA1c and lipid profile testing and urine, foot and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure and HbA1c), and co-morbidity of hypertension. The associations between the score and the incidence of AMI were evaluated using Cox regression models.

RESULTS

A total of 7351 patients who had sufficient information to calculate the score were enrolled. In comparison with participants who had scores ≤ 1, those with scores between 2 and 4 had a lower risk of developing AMI [adjusted hazard ratio (AHR) = 0.71; 95% confidence interval (95%CI): 0.55-0.90], and those with scores ≥ 5 had an even lower risk (AHR = 0.37; 95%CI: 0.21-0.66).

CONCLUSION

Good quality of care can reduce the risk of AMI in patients with type 2 DM. The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.

Keywords: Acute myocardial infarction, Cardiovascular disease, Diabetes mellitus, Quality-of-care, Score

Core Tip: Cardiovascular disease is the leading cause of death globally, and diabetes mellitus (DM) is a major modifiable factor. Hypothesizing that good quality of care can reduce the risk of acute myocardial infarction (AMI) in patients with DM, we developed a long-term quality-of-care score for predicting the occurrence of AMI in patients with type 2 DM. In 7351 patients, we observed a good association between the score and the risk of AMI. Therefore, good quality of care can reduce the risk of AMI in patients with DM, and the score can be applied to guiding the care for these patients.