Coronary heart disease (CHD) is a leading cause of morbidity, mortality, and health-system costs. When Type 2 diabetes mellitus (T2DM) coexists with CHD, the combined burden on patients and services increases. This linked-data analysis aimed to examine real-world care pathways for people with CHD and T2DM and to identify healthcare interactions associated with improved outcomes following an index CHD presentation to an emergency department (ED).
The study used linked administrative datasets from Western Australia spanning 2010–2022. Linked sources included records from general practice (GP) encounters, emergency department presentations, inpatient admissions, and mortality registries. CHD cases were defined using ICD-10-AM codes I20–I25 and identified at ED presentation as the index event. The subgroup with comorbid T2DM comprised 2,085 patients; their subsequent care pathways and outcomes were analyzed.
Care-pathway characterization employed descriptive statistics to summarize healthcare interactions across GP, ED, and inpatient settings. Associations between elements of the pathway and outcomes were modeled using Cox regression and discrete-time survival models. The analysis evaluated the impact of GP visit frequency occurring before and after the index CHD event on the odds of recurrent rehospitalization and on mortality risk. Adjusted effect estimates and 95% confidence intervals are reported for the principal associations.
The analysis produced contrasting associations for GP engagement before versus after the index CHD presentation:
A doubling of post-CHD GP visits was associated with a reduction in the odds of recurrent rehospitalization (adjusted odds ratio [aOR] = 0.94; 95% confidence interval [CI], 0.92–0.97).
The same increase in post-CHD GP visits was associated with lower mortality risk (adjusted hazard ratio [aHR] = 0.87; 95% CI, 0.84–0.90).
Conversely, a doubling of pre-CHD GP visits was associated with increased odds of rehospitalization (aOR = 1.04; 95% CI, 1.01–1.06) and higher mortality risk (aHR = 1.09; 95% CI, 1.05–1.11).
The authors note that higher pre-event GP utilization likely reflects greater baseline illness burden or healthcare need prior to the index CHD event, whereas increased GP engagement after the event was linked to improved outcomes.
The study identified geographic and clinical factors associated with worse outcomes among the CHD + T2DM cohort:
Residence in outer regional areas was associated with higher odds of rehospitalization.
Increased age, remote residence, and the presence of comorbid heart failure or chronic kidney disease were associated with elevated mortality risk.
These findings indicate socioeconomic and access-related gradients in post-CHD outcomes among people with T2DM.
Prescription patterns reported in the cohort included:
Overall, 73.7% of patients received at least one guideline-recommended CHD medication.
Among glucose-lowering therapies, 34.0% of patients were prescribed metformin. Metformin was frequently used alongside insulin, and use of dipeptidyl peptidase-4 inhibitors was also observed.
The abstract provides these summary medication rates but does not report further detail on medication classes, dosing, adherence, or temporal patterns beyond these proportions.
Using linked administrative data, the study showed that greater GP engagement following CHD events was associated with fewer recurrent hospitalizations and reduced mortality among people with CHD and comorbid T2DM. Higher GP use before the index event was associated with worse outcomes, interpreted as a marker of higher pre-existing risk. Geographic disparities and comorbid conditions such as heart failure and chronic kidney disease identified subgroups at higher risk.
The authors suggest that strengthening primary–secondary care coordination and enhancing post-event primary care follow-up may improve survival and decrease rehospitalization, thereby reducing long-term healthcare burden. Specific implementation strategies, detailed model covariates, and study limitations were not reported in the abstract and therefore are not available from the source provided.