Contemporary characteristics and management of patients with myocardial infarction and diabetes in Europe: Insights from EuroHeart
A Haider, C P Gale, A Irs, G Range, A Janosi, I J Gudmundsdottir, P Kerney, A P Maggioni, K H Bonaa, M Oliveira Santos, C Udroiu, J Yap, J Alfredsson, L Raber, G BatraAbstract
Background
Diabetes is an important and global health challenge and a risk factor for myocardial infarction (MI), which is associated with adverse outcomes. To support systematic improvements in cardiovascular care, many countries have established national quality registries to monitor patient characteristics, treatments and outcomes. The European Unified Registries on Heart Care Evaluation and Randomised Trials (EuroHeart) initiative provides an infrastructure for continuous prospective collection of harmonised clinical variables to support and improve the quality of cardiovascular care in Europe.
Purpose
To describe baseline characteristics, comorbidities and treatment patterns among patients with MI, with a focus on those with diabetes, in EuroHeart countries reporting data in 2024.
Methods
Continuous data on patients admitted with MI were collected in participating hospitals across 13 EuroHeart countries in 2024, using variables defined by the EuroHeart data standards. Data were submitted in aggregated form from England and Wales, Estonia, France, Hungary, Iceland, Ireland, Italy, Norway, Portugal, Romania, Singapore, Sweden and Switzerland. Variables included baseline characteristics, in-hospital care and discharge treatments. Individual patient-level data were aggregated at national level by age group, sex and diabetes status prior to central statistical analysis. Data are presented as proportions and means/medians to facilitate visual comparison.
Results
A total of 173,050 patients with MI were included in 2024 across 13 countries, of whom nearly 32% were women. Diabetes was present in 28% of patients. Those with diabetes were older (mean age 69 years) than those without diabetes (66 years) and had a substantially higher burden of comorbidities, including hypertension and chronic kidney disease (Figure 1). A high proportion of patients underwent coronary angiography (94%) and percutaneous coronary intervention (76%), irrespective of diabetes status. Similarly, only minor differences were observed in the prescription of antiplatelet agents, lipid-lowering therapy, and ACE inhibitors/ARBs between patients with and without diabetes. Among patients with diabetes, 54% (range 28–81%) received metformin, while cardioprotective glucose-lowering therapies were prescribed at discharge to 9% (2–25%) for glucagon-like peptide-1 receptor agonists (GLP-1 RA) and 55% (40–76%) for sodium-glucose cotransporter-2 (SGLT2) inhibitors, with variation between countries (Figure 2).
Conclusions
In 2024, nearly one-third of patients with MI in EuroHeart had diabetes, which was associated with older age and a higher burden of comorbidities. Despite similar use of coronary interventions and standard cardiovascular therapies between patients with and without diabetes, the prescription of GLP-1 RA and SGLT2 inhibitors varied widely across countries, highlighting opportunities to optimise diabetes management in patients with MI.Figure 1Figure 2