Health literacy reflects the ability to make appropriate health decisions and affects health outcomes. It therefore is an important parameter in patient care. The purpose of this study was to investigate the health literacy of patients undergoing coronary angiography. We enrolled 697 consecutive patients undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in central Europe. Health literacy was measured using the validated HLS- EU-Q16 questionnaire. A response rate of 79.5% was achieved. Overall, 222 patients (31.9%) had type 2 diabetes (T2DM). The mean age was 67.6±10.9 years, 272 patients were <65 years and 425 patients ≥65 years. Comparing T2DM patients to those who did not have diabetes, overall median health literacy scores (HLS) were 12.0 [IQR:10-15] vs. 13 [IQR:10-15] among patients <65 years (p=0.655) and 12 [IQR:10-16] vs. 13 [IQR:11-15] among older patients ≥65 years (p=0.856). Prevalence rates of adequate (HLS 13-16), problematic (HLS 9-12) and inadequate (HLS 0-8) health literacy did not differ significantly in patients with T2DM vs. subjects without T2DM in both age groups: 49.2% vs. 56.1%, 34.4% vs. 27.8% and 16.4% vs. 16.1% among patients <65 years and 49.5% vs. 56.4%, 36.0% vs. 30.7% and 14.4% vs. 12.9% among patients ≥65 years, respectively. We conclude that among patients undergoing coronary angiography for the evaluation of established or suspected stable CAD health literacy is suboptimal, regardless of diabetes status and age.

Chronic medical conditions such as type 2 diabetes (T2DM) or coronary artery disease (CAD) and their treatment have a crucial impact on patients’ daily life. The EQ-5D-5L questionnaire is a validated and widely used tool to measure the health-related quality of life (HRQL). We investigated and compared the HRQL in patients with or without T2DM and CAD. We included 481 consecutive patients undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in Central Europe. Patients’ HRQL was measured using the EQ-5D-5L, comprising the EQ index calculated from the domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. A response rate of 88.1% was achieved. From our patients, 166 (34.5%) had T2DM according to ADA criteria, and 254 (52.8%) had significant CAD with stenoses ≥50% at angiography. Patients with T2DM showed significantly lower EQ index values than patients without T2DM (0.891 [IQR=0.783-0.970]) vs. 0.943, [IQR=0.861-1.0], p=0.002)). Regarding the different dimensions of the questionnaire, patients with T2DM reported to have significantly more problems with anxiety and depression (p=0.002) and mobility (p<0.001) than nondiabetic patients. EQ index values in contrast did not differ significantly between patients with vs. those without significant CAD. Accordingly, in analysis of covariance T2DM (F=7.38, p=0.007) but not significant CAD (F=1.74, p=0.183) predicted EQ index values after adjustment for age, sex and body-mass-index. We conclude that T2DM rather than the presence of significant CAD is associated with quality of life in angiographied coronary patients. Disclosure M. Ratz: None. J. Vogel: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.

A complete medication plan (MPlan) increases medication safety and adherence and is crucial in care transitions. Countries that implemented a standardized MPlan reported benefits on patients’ understanding and handling of their medication. Austria lacks such a standardization, with no available data on the issue. Objective: This study aimed to investigate the current state of all medication documentations (MDocs) at hospital admission in a population at high risk for polypharmacy in Austria. Methods: We enrolled 512 consecutive patients undergoing elective coronary angiography. Their MDocs and medications were recorded at admission. MDocs were categorized, whereby a MPlan was defined as a tabular list including medication name, dose, route, frequency and patient name. Results: Out of 485 patients, 55.1% had an MDoc (median number of drugs: 6, range 2–17), of whom 24.7% had unstructured documentation, 18.0% physicians’ letters and 54.3% MPlans. Polypharmacy patients did not have a MDoc in 31.3%. Crucial information as the patients’s name or the originator of the MDoc was missing in 31.1% and 20.4%, respectively. Patients with MDoc provided more comprehensive medication information (p = 0.019), although over-the-counter-medication was missing in 94.5% of MDocs. A discrepancy between the MPlan and current medication at admission existed in 64.4%. In total, only 10.7% of our patient cohort presented an MPlan that was in accordance with their current medication. Conclusion: The situation in Austria is far from a standardized MPlan generated in daily routine. Numerous MPlans do not represent the current medication and could pose a potential risk for the effectiveness and safety of pharmacotherapy.

AIM:Over recent years, therapy options and strategies for type 2 diabetes mellitus (T2DM) have developed substantially. This study investigated glucose-lowering treatment in patients with high cardiovascular risk over three decades. MATERIALS AND METHODS:A total of 2158 patients undergoing elective coronary angiography at a tertiary care hospital in Europe were included in three sequential observational studies (OS): OS1 (1999-2000; n = 672), OS2 (2005-2008; n = 1005) and OS3 (2022-2023; n = 481). Sociodemographic data, patient-reported medication, medical histories and blood samples were analysed. RESULTS:A clear trend towards more complex glucose-lowering therapies was found. A wider array of glucose-lowering drugs was used over time (OS1: 11; OS2: 21; OS3: 25) and the number of different drugs used in combination therapy in a single patient increased to a maximum of five in OS3. Furthermore, substantial differences in applied medication regimens were observed: Sodium-glucose cotransporter-2 inhibitors were the most frequently reported substance class (34.0% of total reported glucose-lowering drugs) in OS3, whilst metformin remained a key component (OS1: 33.9%; OS2: 41.8%; OS3: 32.0%). Other drug classes like sulfonylureas were largely replaced. A total of 69.2% of patients in OS3 achieved an HbA1c level of < 7% (vs. OS1: 51.9%, OS2: 54.7%; ptrend < 0.001). Over 25% of patients with T2DM were newly diagnosed at admission (OS1: 43.8%, OS2: 29.7%, OS3: 27.2%; ptrend < 0.001) and had therefore no diabetes-related medication. CONCLUSION:These real-world data emphasize a marked shift in T2DM treatment towards novel substance classes. However, the use of incretin mimetics remained low. Significantly more patients reached HbA1c targets in the most recent cohort.

Lipid-lowering therapy (LLT) is key to reducing the burden of macrovascular diabetes complications. Here, we aim to assess long-term trends in LLT and LDL-C levels among patients with type 2 diabetes (T2DM) with angiographically proven coronary artery disease (CAD). We investigated T2DM patients (n=590), who were referred to elective coronary angiography and were diagnosed with CAD in one of three observational cohort studies (OS) spanning 25 years: OS1: 1999-2000 (n=190); OS2: 2005-2008 (n=241); OS3: 2022-2023 (n=159). These studies were conducted at the same cardiology unit of a tertiary care hospital in Central Europe. The proportion of patients receiving statin therapy (C10AA and C10AB) increased significantly from 57.9% in OS1 to 64.3% in OS2 and 78.6% in OS3 (ptrend<0.001). Further, there was an increase in patients receiving high-intensity statin therapy, rising from none in OS1 to 8.5% in OS2 and 73.4% in OS3 (ptrend<0.001). The proportion of patients receiving more than one LLT compound also increased (OS1: 2.1%; OS2: 2.1%; OS3: 35.2%; ptrend<0.001). Use of ezetimibe (C10AX09) increased (OS1: 0.0%; OS2: 1.2%; OS3: 39.0%; ptrend<0.001) and fibrate use (C10AB) decreased (OS1: 5.3%; OS2: 3.3%; OS3: 0.6%; ptrend=0.015). Newly approved compounds (C10AX13 - C10AX16) were prescribed for 3.8% of patients in OS3. Among statin combination therapies, ezetimibe was predominantly used (93.5%). Mean LDL-C levels declined significantly from 123±38 mg/dL (OS1) to 115±39 mg/dL (OS2) and 77±38 mg/dL (OS3; ptrend<0.001). However, only 2.2% of patients in OS1, 2.5% in OS2 and 32.1% in OS3 reached an LDL-C target of <55 mg/dL (ptrend<0.001). This analysis suggests an upward trend in treatment intensity and a substantial improvement in LDL-C levels among T2DM patients with CAD. However, the majority of these patients still does not reach their LDL-C target. Disclosure J. Vogel: None. M. Ratz: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.

The utilization of multiple medications and the increasing complexity of medication regimens associated with chronic diseases such as type 2 diabetes (T2DM) necessitate the implementation of a medication documentation (MD). A complete medication plan serves to enhance medication safety and promotes adherence. The availability of MD in the clinically important population of T2DM patients undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD) remains unknown and is addressed in the present study. We analyzed MD, current medication status, and the Medication Regimen Complexity Index (MRCI) in 515 consecutive patients who underwent coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD). Our cohort included 177 patients (34%) with T2DM and 338 patients (66%) without diabetes. Patients with T2DM compared to those without diabetes had a significantly higher number of medications (7 [5-9] vs. 5 [3-6]; p<0.001) and a significantly higher complexity in medication regimens (17 [11-24] vs. 12 [7-16]; p<0.001). Specifically, out of 104 (59%) T2DM patients, MD was available, while 73 (41%) lacked MD. Further classification showed the following categories of MD in patients with diabetes: unstructured documentation in 28 (27%), physician’s letter in 17 (16%), medication plan in 58 (56%) and other categories in 1 (1%). We conclude that patients with T2DM who undergo coronary angiography for the evaluation of established or suspected stable CAD are affected by a high medication complexity and polypharmacy, which highlights the importance of an accurate MD in these patients. However, proper MD is not available in almost half of these patients. Disclosure P. Elsner: None. M. Ratz: None. J. Vogel: None. C.H. Saely: None. T. Plattner: None. A. Mader: None. B. Larcher: None. A. Vonbank: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.

Satisfaction with information regarding pharmaceutic therapy is important because it may strongly affect the appropriate use of drug therapy including medication adherence. Data on this parameter in the clinically important population of patients with type 2 diabetes (T2DM) undergoing coronary angiography is scarce and is therefore addressed in the present study. We consecutively enrolled a cohort of 515 patients (383 men and 132 women) who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease. Satisfaction with information regarding pharmaceutic therapy was measured using the validated Satisfaction with Information about Medicines Scale (SIMS-D) which consists of two sub-scales covering action and usage (questions 1-9) or potential problems (questions 10-17), respectively. Further, health literacy, which includes the ability to understand and follow instructions for treatment was determined using the EU-HLS-Q16 questionnaire. For SIMS-D a response rate of 68.4% (n=353, 280 men and 73 women) was achieved. From our patients, 124 (36.4% of males and 30.1% of females) had T2DM according to ADA criteria. SIMS-D scores did not differ significantly between T2DM patients and those who did not have diabetes among men 11.5 [IQR=6-16] vs. 9 [IQR=6-15] p=0.121, nor among women 10 [IQR=5.5-12.25] vs. 10 [IQR=5-17] p=0.537. Independent of gender and diabetes status patients scored significantly lower on items targeting satisfaction with information about potential problems of medication than the in sub-scale for action and usage (p<0.001). In analysis of covariance, health literacy independently of T2DM, gender and age predicted SIMS-D (F=41.3; p<0.001). From our findings we conclude that satisfaction with information about medicines in angiographied coronary patients does not depend on the presence of T2DM or gender but is significantly impacted by health literacy. J. Vogel: None. M. Ratz: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.

Abstract Chronic medical conditions such as type 2 diabetes (T2DM) or coronary artery disease (CAD) and their treatment have a crucial impact on patients’ daily life. The EQ-5D-5L questionnaire is a validated and widely used tool to measure the health-related quality of life (HRQL). We investigated and compared the HRQL in patients with or without T2DM and CAD. We included 481 consecutive patients undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in Central Europe. Patients’ HRQL was measured using the EQ-5D-5L, comprising the EQ index calculated from the domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. A response rate of 88.1% was achieved. From our patients, 166 (34.5%) had T2DM according to ADA criteria, and 254 (52.8%) had significant CAD with stenoses ≥50% at angiography. Patients with T2DM showed significantly lower EQ index values than patients without T2DM (0.891 [IQR=0.783-0.970]) vs. 0.943, [IQR=0.861-1.0], p=0.002)). Regarding the different dimensions of the questionnaire, patients with T2DM reported to have significantly more problems with anxiety and depression (p=0.002) and mobility (p<0.001) than non-diabetic patients. EQ index values in contrast did not differ significantly between patients with vs. those without significant CAD. Accordingly, in analysis of covariance T2DM (F=7.38, p=0.007) but not significant CAD (F=1.74, p=0.183) predicted EQ index values after adjustment for age, sex and body-mass-index. We conclude that T2DM rather than the presence of significant CAD is associated with quality of life in angiographied coronary patients.

Health literacy reflects the ability to make appropriate health decisions and affects health outcomes. It therefore is an important parameter in patient care and for health care providers. Health literacy in patients undergoing coronary angiography, the standard procedure for the definite evaluation of coronary artery disease (CAD) is unclear and is addressed in the present study. We recruited 515 consecutive patients (383 men and 132 women) undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in central Europe. Health literacy was measured using the validated HLS-EU-Q16 questionnaire. A response rate of 80.4% was achieved. Overall, 177 patients (i.e. 34.3% of the cohort) had type 2 diabetes (T2DM); the prevalence of T2DM was 36.8% in men and in 27.3% in women (p=0.047). Comparing T2DM patients to those who did not have diabetes, overall median health literacy scores (HLS) were 13 [IQR=11-15] vs. 13 [IQR=10-15] among men (p=0.424) and 12 [IQR=10-15] vs. 13 [IQR=10.25-15] among women (p=0.517). Prevalence rates of adequate (HLS 13-16), problematic (HLS 9-12) and inadequate (HLS 0-8) health literacy did not differ significantly between patients with T2DM vs. subjects without T2DM (53.0% vs. 55.4%, 34.8% vs. 29.9% and 12.2% vs. 14.7% among men and 37.5% vs. 55.6%, 45.8% vs. 31.9% and 16.7% vs. 12.5% among women, respectively. We conclude that among patients undergoing coronary angiography for the evaluation of established or suspected stable CAD, health literacy regardless of sex is suboptimal both in patients with T2DM and in non-diabetic subjects.

Remnant cholesterol has attracted interest as a marker of cardiovascular event risk. The power of remnant cholesterol to predict major cardiovascular events (MACE) in patients with differing fasting glucose state is unclear and is addressed in the present study. We prospectively recorded MACE including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke in a high-risk cohort of 1787 patients with cardiovascular disease,1472 had angiographically proven coronary artery disease and 315 had sonographically proven peripheral artery disease, over a mean follow-up period of 10.7±5.0 years. At baseline, remnant cholesterol significantly increased from patients with NFG (n=690) over those with IFG (n=505) to those with T2DM (n=592; 19±21 mg/dl, 24±23 mg/dl and 26±24 mg/dl, respectively; ptrend<0.001). During follow-up, 719 of our patients suffered MACE; the incidence of MACE in subjects with NFG, IFG and T2DM was 37.8%, 34.4% and 49.1%, respectively, ptrend<0.001.Remnant cholesterol in the total study population predicted MACE (standardized adjusted HR 1.17 [1.09-1.27], p<0.001) in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol and also after additional adjustment for the baseline glycemic state (HR=1.15 [1.07-1.23], p<0.001). In subgroup analyses, standardized adjusted HR were 1.19 [1.05-1.35], p=0.005), 1.12 [0.96-1.30], p=0.146) and 1.15 [1.02-1.29], p=0.025) in patients with NFG, IFG and T2DM, respectively. An interaction term remnant cholesterol by glycemic state was not significant (p=0.363), indicating that the glycemic state did not significantly impact the power of remnant cholesterol to predict MACE. From our data we conclude that remnant cholesterol is a predictor of MACE in CVD patients irrespective of the baseline glycemic state. Disclosure H. Drexel: None. T. Plattner: None. B. Larcher: None. A. Mader: None. A. Vonbank: None. P. Elsner: None. A. Leiherer: None. A. Muendlein: None. C.H. Saely: None.

Health literacy reflects the ability to make appropriate health decisions and affects health outcomes. It therefore is an important parameter in patient care and for health care providers. Health literacy in patients undergoing coronary angiography, the standard procedure for the definite evaluation of coronary artery disease (CAD) is unclear and is addressed in the present study. We recruited 515 consecutive patients (383 men and 132 women) undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in central Europe. Health literacy was measured using the validated HLS-EU-Q16 questionnaire. A response rate of 80.4% was achieved. Overall, 177 patients (i.e. 34.3% of the cohort) had type 2 diabetes (T2DM); the prevalence of T2DM was 36.8% in men and in 27.3% in women (p=0.047). Comparing T2DM patients to those who did not have diabetes, overall median health literacy scores (HLS) were 13 [IQR=11-15] vs. 13 [IQR=10-15] among men (p=0.424) and 12 [IQR=10-15] vs. 13 [IQR=10.25-15] among women (p=0.517). Prevalence rates of adequate (HLS 13-16), problematic (HLS 9-12) and inadequate (HLS 0-8) health literacy did not differ significantly between patients with T2DM vs. subjects without T2DM (53.0% vs. 55.4%, 34.8% vs. 29.9% and 12.2% vs. 14.7% among men and 37.5% vs. 55.6%, 45.8% vs. 31.9% and 16.7% vs. 12.5% among women, respectively. We conclude that among patients undergoing coronary angiography for the evaluation of established or suspected stable CAD, health literacy regardless of sex is suboptimal both in patients with T2DM and in nondiabetic subjects. M. Ratz: None. J. Vogel: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.

Satisfaction with information regarding pharmaceutic therapy is important because it may strongly affect the appropriate use of drug therapy including medication adherence. No data on this parameter are available in the clinically important population of patients with type 2 diabetes (T2DM) undergoing coronary angiography. We therefore consecutively enrolled a cohort of 272 patients who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease (CAD) from March through December 2022. From our patients, 94 (34.4% of the total study population) had T2DM according to ADA criteria. Satisfaction with information regarding pharmaceutic therapy was measured using the validated Satisfaction with Information about Medicines Scale (SIMS-D) which consists of two sub-scales covering action and usage or potential problems, respectively. Further, health literacy, which includes the ability to understand and follow instructions for treatment was determined using the EU-HLS-Q16 questionnaire. SIMS-D questionnaires were returned by 196 (71.8%) and EU-HLS-Q16 by 229 (83.9%) patients. Median total SIMS-D scores did not differ significantly between T2DM patients and nondiabetic subjects (11, interquartile range (IQR) 9 vs. 9, IQR 8; p=0.383); independent of T2DM status patients scored significantly lower on items targeting satisfaction with information about potential problems of medication than the in sub-scales for action and usage (p<0.001). In analysis of covariance, health literacy independently of age and T2DM predicted SIMS-D (F=18.55; p<0.001). From our findings we conclude that satisfaction with information about medicines in angiographied coronary patients does not depend on the presence of T2DM but is significantly impacted by health literacy. Disclosure M. Ratz: None. J. Vogel: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. L. Sprenger: None. M. Maechler: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.