Linking Percutaneous Coronary Intervention (PCI) Services to Primary-Care Diabetes Clinics in a Conflict-Affected Health System: Six-Month Lipid, Glycaemic and Adherence Outcomes among People with Type 2 Diabetes in Palestine
1
FAMILY MEDICINE, PALESTINE POLYTECHNIC UNIVERSITY , PALESTINE ACADEMY OF SCIENCE AND TECHNOLOGY ,, HEBRON, Palestinian Territory, Occupied
2
sudanese academy of young scientists, khartoum, Sudan
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Post-percutaneous coronary intervention (PCI) patients with type 2 diabetes mellitus (T2DM) in low-resource settings often miss timely lipid optimization and adherence support. We evaluated a protocolized transition-of-care pathway linking tertiary PCI services to primary-care diabetes clinics.
OBJECTIVE:
Primary: determine whether the pathway increases the proportion of achieving LDL-C <55 mg/dL at 6 months versus a historical cohort. Secondary: effects on absolute LDL-C reduction, HbA1c change, adherence (PDC ≥80%), ≤30-day clinic attendance, major adverse cardiovascular events (MACE), and bleeding (BARC ≥2).
METHODS:
The study employed a single-center prospective cohort in Palestine, utilizing a pre-implementation historical comparator. Adults with T2DM undergoing PCI were followed for 6 months (post-pathway N=220; historical N=200). The pathway comprised discharge counselling and written referral ≤30 days, guideline-directed lipid lowering (high-intensity statin with early ezetimibe/PCSK9 consideration), brief phone/WhatsApp reminders, and scheduled 6-month laboratories. Analyses used χ²/t-tests and multivariable logistic regression.
RESULTS:
LDL-C <55 mg/dL was achieved by 20.9% (46/220) post-pathway vs 11.5% (23/200) historically (χ²=6.09, p=0.0136). Mean LDL-C at 6 months was 67.4 mg/dL (95% CI 65.3–69.6) vs 79.7 mg/dL (95% CI 76.9–82.4); p<0.001, with larger absolute reductions (−39.6 vs −27.6 mg/dL; p<0.001). HbA1c at 6 months was 7.41% (95% CI 7.29–7.53) vs 7.90% (95% CI 7.75–8.05); p<0.001. Adherence improved (PDC ≥80%: 71.4% [157/220] vs 60.0% [120/200]; p=0.0187), and 77.3% (170/220) attended clinic within ≤30 days. Safety was comparable (MACE 7.3% vs 7.0%, p=1.0000; BARC ≥2 0.9% vs 1.5%, p=0.9146). The pathway independently predicted LDL-C <55 mg/dL (aOR 1.99, 95% CI 1.15–3.43; p=0.0137).
CONCLUSIONS:
A protocolized post-PCI transition-of-care pathway is feasible in a resource-limited setting and improves LDL-C target attainment and adherence without excess harm
Post-percutaneous coronary intervention (PCI) patients with type 2 diabetes mellitus (T2DM) in low-resource settings often miss timely lipid optimization and adherence support. We evaluated a protocolized transition-of-care pathway linking tertiary PCI services to primary-care diabetes clinics.
OBJECTIVE:
Primary: determine whether the pathway increases the proportion of achieving LDL-C <55 mg/dL at 6 months versus a historical cohort. Secondary: effects on absolute LDL-C reduction, HbA1c change, adherence (PDC ≥80%), ≤30-day clinic attendance, major adverse cardiovascular events (MACE), and bleeding (BARC ≥2).
METHODS:
The study employed a single-center prospective cohort in Palestine, utilizing a pre-implementation historical comparator. Adults with T2DM undergoing PCI were followed for 6 months (post-pathway N=220; historical N=200). The pathway comprised discharge counselling and written referral ≤30 days, guideline-directed lipid lowering (high-intensity statin with early ezetimibe/PCSK9 consideration), brief phone/WhatsApp reminders, and scheduled 6-month laboratories. Analyses used χ²/t-tests and multivariable logistic regression.
RESULTS:
LDL-C <55 mg/dL was achieved by 20.9% (46/220) post-pathway vs 11.5% (23/200) historically (χ²=6.09, p=0.0136). Mean LDL-C at 6 months was 67.4 mg/dL (95% CI 65.3–69.6) vs 79.7 mg/dL (95% CI 76.9–82.4); p<0.001, with larger absolute reductions (−39.6 vs −27.6 mg/dL; p<0.001). HbA1c at 6 months was 7.41% (95% CI 7.29–7.53) vs 7.90% (95% CI 7.75–8.05); p<0.001. Adherence improved (PDC ≥80%: 71.4% [157/220] vs 60.0% [120/200]; p=0.0187), and 77.3% (170/220) attended clinic within ≤30 days. Safety was comparable (MACE 7.3% vs 7.0%, p=1.0000; BARC ≥2 0.9% vs 1.5%, p=0.9146). The pathway independently predicted LDL-C <55 mg/dL (aOR 1.99, 95% CI 1.15–3.43; p=0.0137).
CONCLUSIONS:
A protocolized post-PCI transition-of-care pathway is feasible in a resource-limited setting and improves LDL-C target attainment and adherence without excess harm
| eISSN: | 2654-1459 |
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