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To the Editor: Dr Fox and colleagues¹ documented a multinational improvement in provision of evidence-based care for patients with acute coronary syndromes (ACS), with reduction in mortality and morbidity associated with these treatments. The study reinforces the need to further improve adherence to evidence-based guidelines and demonstrates the clinical benefit that can be achieved with such a strategy.

However, Fox et al did not assess the temporal pattern in outcomes in patients with diabetes. In a study examining the changing patterns in outcome after acute myocardial infarction (AMI) in multiple hospitals in the United Kingdom, we analyzed data from more than 3000 unselected patients sustaining an AMI in either 1995 or 2003 and assessed changes in care and all-cause mortality at 30 days and 18 months.² Our data support those of Fox et al showing improved quality of care for all patients with AMI. However, patients with diabetes did not . . . [Full Text of this Article]

Richard M. Cubbon, MBChB; Christopher P. Gale, PhD; Peter J. Grant, MD; Alistair S. Hall, PhD; Mark T. Kearney, MD
m.t.kearney@leeds.ac.uk
Leeds Institute of Genetics, Health and Therapeutics
University of Leeds
Leeds, England

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