title: Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010.
abstract: OBJECTIVE
  To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes.
  
  
  METHODS
  We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type.
  
  
  RESULTS
  26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sex-standardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88).
  
  
  CONCLUSIONS
  Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.
authors.affiliation: School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Lee
authors.initials: L
authors.lastname: Nedkoff
authors.affiliation: School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Knuiman
authors.affiliation: School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
authors.affiliation: School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications*; D003710:Demography; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008501:Medical Records, Problem-Oriented / Q000706:statistics & numerical data; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors