Published online Jul 15, 2023. doi: 10.4239/wjd.v14.i7.1091
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
Processing time: 184 Days and 1 Hours
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.
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.
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.
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).
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.
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.