---
title: "Healthcare pathways and outcomes for Australians with Coronary Heart Disease and Type 2 Diabetes:"
id: "pubmed-41849657"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41849657"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41849657/"
doi: "10.1093/eurjcn/zvag079"
published_at: "2026-09-08T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Healthcare pathways and outcomes for Australians with Coronary Heart Disease and Type 2 Diabetes:
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41849657
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41849657/)
- **DOI:** [10.1093/eurjcn/zvag079](https://doi.org/10.1093%2Feurjcn%2Fzvag079)
- **Published At:** 2026-09-08T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This linked-data study examined healthcare interactions and outcomes among people with **coronary heart disease (CHD)** and comorbid **Type 2 diabetes mellitus (T2DM)** in Western Australia using administrative datasets from 2010–2022. - Data sources included general practice (GP) records, emergency department (ED) presentations, inpatient admissions, and mortality registries linked around an ED index presentation for CHD (ICD-10-AM I20–I25). - The analytic cohort with T2DM comprised 2,085 patients whose care pathways were characterized with descriptive statistics and modeled using Cox regression and discrete-time survival methods. - A doubling of **post-CHD GP visits** was associated with lower odds of recurrent **rehospitalization** (adjusted odds ratio [aOR] = 0.94; 95% CI, 0.92–0.97) and reduced **mortality** risk (adjusted hazard ratio [aHR] = 0.87; 95% CI, 0.84–0.90). - In contrast, a doubling of **pre-CHD GP visits** correlated 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), interpreted as likely reflecting greater baseline illness burden prior to the index CHD event. - Geographic disparities were observed: patients in **outer regional** areas had higher odds of rehospitalization; **older age**, **remote residence**, and comorbid **heart failure** or **chronic kidney disease** were associated with higher mortality. - Medication patterns: 73.7% of patients received at least one guideline-recommended CHD medication. Among glucose-lowering therapies, 34.0% were prescribed **metformin**, often in combination with **insulin** and with use of **dipeptidyl peptidase-4 inhibitors** noted. - The authors conclude that strengthening **primary–secondary care coordination** and enhancing GP engagement following CHD events may improve survival and reduce rehospitalizations and long-term healthcare burden. - Details such as sample selection criteria beyond ICD-10-AM codes, covariates included in models, and study limitations were not reported in the abstract and therefore are not available from the source provided.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/41849657/#linkout) Title & authors Abstract Conflict of interest statement Similar articles MeSH terms Related information LinkOut - more resources Eur J Cardiovasc Nurs Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+J+Cardiovasc+Nurs%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+J+Cardiovasc+Nurs%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41849657/) . 2026 Sep 8;25(6):1170-1182. doi: 10.1093/eurjcn/zvag079. # Healthcare pathways and health outcomes among people with coronary heart disease and Type 2 diabetes in Australia: a linked data analysis [Sangita Shakya](https://pubmed.ncbi.nlm.nih.gov/?term=Shakya+S&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Sean Randall](https://pubmed.ncbi.nlm.nih.gov/?term=Randall+S&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Suzanne Robinson](https://pubmed.ncbi.nlm.nih.gov/?term=Robinson+S&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Paul A Agius](https://pubmed.ncbi.nlm.nih.gov/?term=Agius+PA&cauthor_id=41849657)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-2 "Faculty of Health, School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC3125, Australia.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-3 "Disease Elimination, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-4 "School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004, Australia."), [Crystal Man Ying Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+CMY&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Kevin E K Chai](https://pubmed.ncbi.nlm.nih.gov/?term=Chai+KEK&cauthor_id=41849657)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-5 "School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, VIC3086, Australia."), [James H Boyd](https://pubmed.ncbi.nlm.nih.gov/?term=Boyd+JH&cauthor_id=41849657)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-5 "School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, VIC3086, Australia."), [Bernard Kwadwo Yeboah Asiamah-Asare](https://pubmed.ncbi.nlm.nih.gov/?term=Asiamah-Asare+BKY&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Richard Varhol](https://pubmed.ncbi.nlm.nih.gov/?term=Varhol+R&cauthor_id=41849657)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-6 "School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia."), [Lan Gao](https://pubmed.ncbi.nlm.nih.gov/?term=Gao+L&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#full-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia.") Affiliations Expand ### Affiliations * 1 Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia. * 2 Faculty of Health, School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC3125, Australia. * 3 Disease Elimination, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia. * 4 School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004, Australia. * 5 School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, VIC3086, Australia. * 6 School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia. * PMID: **41849657** * DOI: [ 10.1093/eurjcn/zvag079 ](https://doi.org/10.1093/eurjcn/zvag079) Free article Item in Clipboard # Healthcare pathways and health outcomes among people with coronary heart disease and Type 2 diabetes in Australia: a linked data analysis Sangita Shakya et al. Eur J Cardiovasc Nurs. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur J Cardiovasc Nurs Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+J+Cardiovasc+Nurs%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+J+Cardiovasc+Nurs%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41849657/) . 2026 Sep 8;25(6):1170-1182. doi: 10.1093/eurjcn/zvag079. ### Authors [Sangita Shakya](https://pubmed.ncbi.nlm.nih.gov/?term=Shakya+S&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Sean Randall](https://pubmed.ncbi.nlm.nih.gov/?term=Randall+S&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Suzanne Robinson](https://pubmed.ncbi.nlm.nih.gov/?term=Robinson+S&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Paul A Agius](https://pubmed.ncbi.nlm.nih.gov/?term=Agius+PA&cauthor_id=41849657)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-2 "Faculty of Health, School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC3125, Australia.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-3 "Disease Elimination, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-4 "School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004, Australia."), [Crystal Man Ying Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+CMY&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Kevin E K Chai](https://pubmed.ncbi.nlm.nih.gov/?term=Chai+KEK&cauthor_id=41849657)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-5 "School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, VIC3086, Australia."), [James H Boyd](https://pubmed.ncbi.nlm.nih.gov/?term=Boyd+JH&cauthor_id=41849657)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-5 "School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, VIC3086, Australia."), [Bernard Kwadwo Yeboah Asiamah-Asare](https://pubmed.ncbi.nlm.nih.gov/?term=Asiamah-Asare+BKY&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia."), [Richard Varhol](https://pubmed.ncbi.nlm.nih.gov/?term=Varhol+R&cauthor_id=41849657)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-6 "School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia."), [Lan Gao](https://pubmed.ncbi.nlm.nih.gov/?term=Gao+L&cauthor_id=41849657)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41849657/#short-view-affiliation-1 "Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia.") ### Affiliations * 1 Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia. * 2 Faculty of Health, School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC3125, Australia. * 3 Disease Elimination, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia. * 4 School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004, Australia. * 5 School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, VIC3086, Australia. * 6 School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia. * PMID: **41849657** * DOI: [ 10.1093/eurjcn/zvag079 ](https://doi.org/10.1093/eurjcn/zvag079) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** Coronary heart disease (CHD) remains a major cause of morbidity, mortality, and healthcare costs. The coexistence of Type 2 diabetes mellitus (T2DM) further amplifies these burdens. This study examined integrated care pathways for individuals with CHD and T2DM to identify healthcare interactions associated with better outcomes. **Methods and results:** Linked administrative datasets (2010-22) from general practices (GPs), emergency departments (ED), inpatient, and mortality records in Western Australia were used. Coronary heart disease cases (ICD-10-AM: I20-I25) presenting to EDs (index event) were matched with healthcare data. Among patients with comorbid T2DM (n = 2085), the care pathway was analysed using descriptive statistics, Cox regression, and discrete-time survival models. A doubling of post-CHD GP visits was associated with reduced odds of recurrent rehospitalization [adjusted odds ratio (aOR) = 0.94; 95% confidence interval (CI), 0.92-0.97] and 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 mortality (aHR = 1.09; 95% CI, 1.05-1.11). Patients living in outer regional areas had higher odds of rehospitalizations, while older age, remote residence, and comorbid heart failure or chronic kidney disease were associated with elevated mortality. Overall, 73.7% of patients received at least one guideline-recommended CHD medication, and 34.0% were prescribed metformin, often alongside insulin, and dipeptidyl peptidase-4 inhibitors. **Conclusion:** Greater GP engagement following CHD was linked to improved survival and fewer rehospitalizations. Pre-CHD GP visits may reflect greater baseline risk. Strengthening primary-secondary care coordination could improve outcomes and reduce long-term healthcare burden. **Keywords:** Care pathway; Continuity of care; Coronary heart disease; Diabetes; Linked administrative data; Primary care. © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest: S.S. and all other authors declare no conflict of interest with this work. ## Similar articles * [ Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America. ](https://pubmed.ncbi.nlm.nih.gov/20153542/) Gagliardino JJ, Kleinebreil L, Colagiuri S, Flack J, Caporale JE, Siri F, Clark C Jr.Gagliardino JJ, et al.Diabetes Res Clin Pract. 2010 Apr;88(1):7-13. doi: 10.1016/j.diabres.2009.12.024. Epub 2010 Feb 12.Diabetes Res Clin Pract. 2010.PMID: 20153542 * [ Perceptions of risk of coronary heart disease among people living with type 2 diabetes mellitus. ](https://pubmed.ncbi.nlm.nih.gov/29119639/) Ammouri AA, Abu Raddaha AH, Natarajan J, D'Souza MS.Ammouri AA, et al.Int J Nurs Pract. 2018 Feb;24(1). doi: 10.1111/ijn.12610. Epub 2017 Nov 9.Int J Nurs Pract. 2018.PMID: 29119639 * [ Economic evaluation protocol for a multicentre randomised controlled trial to compare Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) versus usual care cardiac rehabilitation among people with coronary heart disease. ](https://pubmed.ncbi.nlm.nih.gov/32847918/) Gao L, Maddison R, Rawstorn J, Ball K, Oldenburg B, Chow C, McNaughton S, Lamb K, Amerena J, Nadurata V, Neil C, Cameron S, Moodie M.Gao L, et al.BMJ Open. 2020 Aug 26;10(8):e038178. doi: 10.1136/bmjopen-2020-038178.BMJ Open. 2020.PMID: 32847918Free PMC article. * [ How diet modification challenges are magnified in vulnerable or marginalize
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