Cardiology · Medical Literature
Improved Cardiac Function and Glycemic Control in Elderly Diabetic Patients Through Structured Case Management After CABG.
Abstract
BACKGROUND Elderly patients with both coronary heart disease (CHD) and diabetes mellitus (DM) undergoing off-pump coronary artery bypass grafting (CABG) face high risks of perioperative glucose fluctuations and impaired recovery. We evaluated the impact of a structured, multidisciplinary case management model on cardiac function and glycemic control in this population. MATERIAL AND METHODS This single-center, randomized controlled trial enrolled 168 elderly (≥65 years) patients with CHD and type 2 DM scheduled for off-pump CABG. Patients were randomized (1: 1) to a control group (CG, n=84; routine care) or an observation group (OG, n=84). The OG received routine care plus a 6-month multidisciplinary intervention including individualized cardiac rehabilitation, modified Mediterranean diet, psychological support, and intensified follow-up. The primary endpoint was 6-month left ventricular ejection fraction (LVEF); HbA1c was a key secondary endpoint. RESULTS All 168 randomized patients were analyzed. At 6 months, the observation group demonstrated significantly superior primary outcomes. LVEF was significantly higher in the OG (mean difference: 6.2%, P<0.001), and HbA1c was significantly lower (mean difference: 1.3%, P<0.001). The intervention group also showed significant improvements in secondary endpoints, including reduced left ventricular diameters (LVESD, LVEDD), an improved lipid profile (P<0.05), longer 6-minute walk test distance, and higher Diabetes-Specific Quality of Life (DSQL) and Activity of Daily Living (ADL) scores (P<0.0001). CONCLUSIONS Structured, multidisciplinary case management significantly improved cardiac function, metabolic control, and functional capacity in elderly diabetic patients after off-pump CABG, validating its efficacy for this high-risk group.
Clinical relevance
In elderly patients (≥65 years) with coronary heart disease and type 2 diabetes mellitus undergoing off-pump CABG, does a structured 6-month multidisciplinary case management program improve left ventricular ejection fraction and glycemic control compared with routine postoperative care? __SNAPSHOT__ {"studyDesign":"Single-center, randomized controlled trial (1:1 allocation)","setting":"Single center; country not specified in the abstract","sampleSize":"n=168 (observation group [OG]: n=84; control group [CG]: n=84)","population":"Elderly patients aged ≥65 years with concurrent coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) scheduled for elective off-pump coronary artery bypass grafting (CABG)","intervention":"Routine postoperative care plus a 6-month structured multidisciplinary case management program comprising individualized cardiac rehabilitation, modified Mediterranean diet, psychological support, and intensified outpatient follow-up","comparator":"Routine postoperative care alone (control group)","primaryOutcome":"Left ventricular ejection fraction (LVEF) at 6 months post-CABG","followUp":"6 months","fundingSource":"Not reported"}
Key findings
All 168 randomized patients were included in the analysis (no attrition reported in the abstract). At 6 months, the observation group demonstrated a statistically significant improvement in the primary endpoint: LVEF was higher in the OG versus the CG with a mean difference of 6.2 percentage points (P<0.001); absolute baseline LVEF values for each group were not reported in the available abstract, precluding calculation of relative improvement or NNT. HbA1c was reported as significantly lower in the OG compared with the CG at 6 months (P value for HbA1c not fully legible in the provided text; reported as significant); specific HbA1c means, standard deviations, and intergroup differences were not reported in the available abstract excerpt. No adverse event rates, hypoglycemia incidence, mortality data, readmission rates, or other safety outcomes were reported in the available abstract text. No confidence intervals were reported for any outcome.
Practice implications
This RCT provides preliminary evidence that a structured, multidisciplinary post-CABG case management model — encompassing cardiac rehabilitation, dietary modification (Mediterranean pattern), psychological support, and intensified follow-up — may meaningfully improve both cardiac systolic function (LVEF +6.2 percentage points) and glycemic control (HbA1c reduction) over 6 months in elderly diabetic patients. A 6.2-percentage-point improvement in LVEF is clinically meaningful by most cardiology benchmarks, as it may shift patients across guideline-defined functional thresholds (e.g., from mildly reduced to preserved LVEF). However, the absence of reported baseline LVEF values, confidence intervals, and absolute HbA1c data substantially limits the precision of effect estimation. The trial cannot distinguish which component(s) of the multimodal intervention drove the observed benefits, as no factorial design was employed. The findings apply specifically to elderly (≥65 years) patients with concurrent CHD and T2DM undergoing off-pump CABG at a single center; generalizability to on-pump CABG, younger patients, those with preserved LVEF at baseline, or patients in health systems with differing baseline care standards is uncertain. Patients with severe comorbidities, advanced heart failure, or cognitive impairment were likely underrepresented, as is typical for single-center RCTs in this population. Long-term outcomes (>6 months), mortality, major adverse cardiovascular events (MACE), hospitalization rates, and quality of life are not reported. IMPORTANT LIMITATION: Only the abstract was available for review; the full manuscript was not accessible, and important methodological details (randomization method, allocation concealment, blinding, statistical analysis plan, missing data handling, and pre-specified secondary endpoints beyond HbA1c) could not be evaluated. __LIMITATIONS__ Single-center design limits generalizability across health systems and centers with differing baseline rehabilitation infrastructure.,The multidisciplinary intervention is a complex bundle; individual contributions of cardiac rehabilitation, dietary change, psychological support, and intensified follow-up cannot be disentangled.,Baseline LVEF values per group are not reported in the abstract, making it impossible to assess whether groups were balanced on the primary outcome at randomization or to contextualize the absolute 6.2% improvement.,No confidence intervals are reported for any outcome, precluding assessment of estimation precision.,HbA1c group means, standard deviations, and intergroup difference are not reported in the available abstract excerpt.,Follow-up limited to 6 months; durability of LVEF and glycemic improvements, and impact on MACE, mortality, and rehospitalization are unknown.,Blinding of patients and care providers to intervention assignment is not feasible for this type of behavioral/rehabilitative intervention, introducing performance and detection bias risk.,Blinding of outcome assessors (e.g., echocardiographers measuring LVEF) is not addressed in the abstract.,Funding source is not reported, precluding assessment of potential conflicts of interest.,Only the abstract was available for review; randomization methodology, allocation concealment, and full statistical analysis plan could not be evaluated. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this single-center RCT of 168 elderly patients with CHD and T2DM undergoing off-pump CABG, a 6-month structured multidisciplinary case management program was associated with a statistically significant 6.2-percentage-point improvement in LVEF and significantly better HbA1c control compared with routine care. While the magnitude of LVEF improvement is clinically plausible and meaningful, the single-center design, absence of confidence intervals, unreported baseline values, and short follow-up preclude definitive practice change; these findings should be considered hypothesis-generating and hypothesis-supporting pending replication in multicenter trials with longer follow-up and MACE endpoints.