Interventions in diabetic patients after myocardial infarction

[Profile of the patient with inadequate follow-up and control of cardiovascular risk factors after suffering an acute myocardial infarction]

OBJECTIVE

To draw up a profile of patients with inadequate follow-up and control of cardiovascular risk factors (CVRF) after acute myocardial infarction (AMI).

DESIGN

Cohort study.

SETTING

Primary care in Albacete, province of Castilla-La Mancha, Spain.

PARTICIPANTS

AMI cases who survived at 28 days and recorded in the IBERICAAlbacete register.

MAIN MEASUREMENTS

A structured survey of patients, families or family doctors to find out about the follow-up and control of CVRFs (arterial hypertension [AHT], hypercholesterolaemia, diabetes, smoking habits, and obesity), as well as education level, work situation and return to work. Inadequate follow-up is defined as when the recommended visits are not made, and inadequate control, when adequate levels are no obtained or they smoked. A descriptive, bivariate, and multivariate comparative analysis was performed. The association was measured using relative risk (RR), and the population estimation with the 95% confidence intervals (95% CI).

RESULTS

The sample included 21% females, 46% hypertensives, 35% with hypercholesterolaemia, 32% diabetics, 36% obeses, and 39% active smokers, with a mean age of 61 years. There was a 9% loss in follow-up, and 576 patients had a CVRF: 31% with inadequate follow-up (95% CI, 28-36) and 46% with inadequate control (95% CI, 41-51). The profile of a patient with inadequate follow-up was young, unemployed, with university education, smoker, obese and without AHT; that of an inadequately controlled patient was, a smoker, diabetic and unemployed.

CONCLUSIONS

There was inadequate follow-up of long term CVRFs in 31% of AMI patients, and 46% with inadequate control, there being characteristics in AMI that identify them.