Aims To determine whether patients with diabetes without prior myocardial infarction (MI) have the same risk of total coronary heart disease (CHD) events as non-diabetic patients with previous myocardial infarction.Methods Using MEDLINE , EMBASE , Cochrane and MeSH in this systematic review and meta-analysis, extensive searching was carried out by cross-referencing from original articles and reviews. The study consisted of cohort or observational studies with hard clinical endpoints, including total CHD events (fatal or non-fatal myocardial infarction), stratified for patients with diabetes but no previous myocardial infarction, and patients without diabetes but with previous myocardial infarction. Studies with less than 100 subjects, follow-up of less than 4 years and/or without provisions for calculating CHD event rates were excluded. The review of articles and data extraction was performed by two independent authors, with any disagreements resolved by consensus.Results Thirteen studies were included involving 45 108 patients. The duration of follow-up was 5-25 years (mean 13.4 years) and the age range was 25-84 years. Patients with diabetes without prior myocardial infarction have a 43% lower risk of developing total CHD events compared with patients without diabetes with previous myocardial infarction (summary odds ratio 0.56, 95% confidence interval 0.53-0.60). ConclusionThis meta-analysis did not support the hypothesis that diabetes is a 'coronary heart disease equivalent'. Public health decisions to initiate cardio-protective drugs in patients with diabetes for primary CHD prevention should therefore be based on appropriate patients' CHD risk estimates rather than a 'blanket' approach of treatment. Diabet. Med. 26, 142-148 (2009) Keywords coronary risk equivalent, diabetes, meta-analysis Abbreviations CHD, coronary heart disease; CI, confidence interval IntroductionIncreased cardiovascular morbidity and mortality in patients with Type 2 diabetes is well established; diabetes is associated with twice the risk of incident coronary heart disease (CHD) and ischaemic stroke and 2-4 times increased risk of CHD and stroke mortality compared with patients without diabetes [1][2][3]. As more than 65% of deaths in patients with diabetes are from cardiovascular causes [4], the management of diabetes mellitus has shifted from a glucocentric approach to an aggressive multifactorial strategy to identify and target patients' cardiovascular risk factors.The widely quoted study by Haffner and colleagues has suggested that people with diabetes without prior myocardial infarction have a similar risk of CHD to those without diabetes who have had a myocardial infarction [5]. The study suggests that patients with diabetes should be treated as if they had existing CHD. This observational study, performed in a Finnish population cohort had some weaknesses, such as the lack of power to detect differences between two groups of patients. In addition, patients in this study were self-selected rather than derived from a po...

Patient complaints are an important source of information for service improvements. We audited patient complaints made about medical care in a National Health Service District general hospital over a 22 month period. Complaints were about medical care, nursing care, attitudes of staff, poor communication, clinical delay (9%) and hospital environment. The complaints department closed 66% complaints within 20 days. The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations.