Healthcare pathways and health outcomes among people with coronary heart disease and Type 2 diabetes in Australia: a linked data analysis.

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.