Disparities in Access and Mortality of Patients With ST-Segment-Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register.

Autor: Oliveira JC; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.; Tiradentes University Aracaju Sergipe Brazil., Almeida-Santos MA; Postgraduate Program in Health and Environment Tiradentes University Aracaju Sergipe Brazil.; Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil., Cunha-Oliveira J; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.; Department of Pharmacy Federal University of Sergipe Lagarto Sergipe Brazil.; Hospital Primavera Aracaju Sergipe Brazil., Oliveira LCS; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.; Hospital Primavera Aracaju Sergipe Brazil., de Carvalho Barreto ID; Hospital Primavera Aracaju Sergipe Brazil., Clair RemacreMunareto Lima T; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil., Andreline Maia Arcelino L; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil., Andrade Prado LF; Surgery Foundation Hospital Aracaju Sergipe Brazil.; Tiradentes University Aracaju Sergipe Brazil., Serra Silveira F; Surgery Foundation Hospital Aracaju Sergipe Brazil., Augusto da Silva Nascimento T; Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.; Heart Hospital Aracaju Sergipe Brazil., Pereira Ferreira EJ; Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.; Surgery Foundation Hospital Aracaju Sergipe Brazil.; Department of Medicine Federal University of Sergipe Lagarto Sergipe Brazil.; Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil., Vasconcelos Barreto R; Surgery Foundation Hospital Aracaju Sergipe Brazil.; Emergency Hospital of Sergipe Aracaju Sergipe Brazil., Vieira Moraes E; Hospital Primavera Aracaju Sergipe Brazil., Teles de Mendonça J; Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.; Heart Hospital Aracaju Sergipe Brazil.; Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil., Sousa ACS; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.; Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.; Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil., Barreto-Filho JA; Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.; Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.; Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2019 Oct 15; Vol. 8 (20), pp. e013057. Date of Electronic Publication: 2019 Oct 04.
DOI: 10.1161/JAHA.119.013057
Abstrakt: Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30-day mortality for patients with ST-segment-elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST-segment-elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30-day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P <0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P <0.001). The 30-day mortality rate of SUS patients was 11.9% and of private patients was 5.9% ( P =0.04). In the fully adjusted model, the odds ratio for 30-day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15-7.61; P =0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30-day follow-up.
Databáze: MEDLINE
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