title: Decade-long trends (1999-2009) in the characteristics, management, and hospital outcomes of patients hospitalized with acute myocardial infarction with prior diabetes and chronic kidney disease.
abstract: BACKGROUND
  Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999-2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities.
  
  
  METHODS
  We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465).
  
  
  RESULTS
  Diabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009).
  
  
  CONCLUSIONS
  Despite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA.
authors.forename: Mayra
authors.initials: M
authors.lastname: Tisminetzky
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA.
authors.forename: Alon
authors.initials: A
authors.lastname: Dor
authors.affiliation: Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA ; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Ruben
authors.initials: R
authors.lastname: Miozzo
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
keywords: chronic kidney disease; diabetes; myocardial infarction