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

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. ME...

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Autores principales: Oliveira, Jussiely Cunha, Almeida‐Santos, Marcos Antonio, Cunha‐Oliveira, Jeferson, Oliveira, Laís Costa Souza, de Carvalho Barreto, Ikaro Daniel, Clair RemacreMunareto Lima, Ticiane, Andreline Maia Arcelino, Larissa, Andrade Prado, Luís Flávio, Serra Silveira, Fábio, Augusto da Silva Nascimento, Thiago, Pereira Ferreira, Eduardo José, Vasconcelos Barreto, Rafael, Vieira Moraes, Enilson, Teles de Mendonça, José, Sousa, Antonio Carlos Sobral, Barreto‐Filho, José Augusto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818046/
https://www.ncbi.nlm.nih.gov/pubmed/31581873
http://dx.doi.org/10.1161/JAHA.119.013057
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author Oliveira, Jussiely Cunha
Almeida‐Santos, Marcos Antonio
Cunha‐Oliveira, Jeferson
Oliveira, Laís Costa Souza
de Carvalho Barreto, Ikaro Daniel
Clair RemacreMunareto Lima, Ticiane
Andreline Maia Arcelino, Larissa
Andrade Prado, Luís Flávio
Serra Silveira, Fábio
Augusto da Silva Nascimento, Thiago
Pereira Ferreira, Eduardo José
Vasconcelos Barreto, Rafael
Vieira Moraes, Enilson
Teles de Mendonça, José
Sousa, Antonio Carlos Sobral
Barreto‐Filho, José Augusto
author_facet Oliveira, Jussiely Cunha
Almeida‐Santos, Marcos Antonio
Cunha‐Oliveira, Jeferson
Oliveira, Laís Costa Souza
de Carvalho Barreto, Ikaro Daniel
Clair RemacreMunareto Lima, Ticiane
Andreline Maia Arcelino, Larissa
Andrade Prado, Luís Flávio
Serra Silveira, Fábio
Augusto da Silva Nascimento, Thiago
Pereira Ferreira, Eduardo José
Vasconcelos Barreto, Rafael
Vieira Moraes, Enilson
Teles de Mendonça, José
Sousa, Antonio Carlos Sobral
Barreto‐Filho, José Augusto
author_sort Oliveira, Jussiely Cunha
collection PubMed
description 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.
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spelling pubmed-68180462019-11-04 Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register Oliveira, Jussiely Cunha Almeida‐Santos, Marcos Antonio Cunha‐Oliveira, Jeferson Oliveira, Laís Costa Souza de Carvalho Barreto, Ikaro Daniel Clair RemacreMunareto Lima, Ticiane Andreline Maia Arcelino, Larissa Andrade Prado, Luís Flávio Serra Silveira, Fábio Augusto da Silva Nascimento, Thiago Pereira Ferreira, Eduardo José Vasconcelos Barreto, Rafael Vieira Moraes, Enilson Teles de Mendonça, José Sousa, Antonio Carlos Sobral Barreto‐Filho, José Augusto J Am Heart Assoc Original Research 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. John Wiley and Sons Inc. 2019-10-04 /pmc/articles/PMC6818046/ /pubmed/31581873 http://dx.doi.org/10.1161/JAHA.119.013057 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Oliveira, Jussiely Cunha
Almeida‐Santos, Marcos Antonio
Cunha‐Oliveira, Jeferson
Oliveira, Laís Costa Souza
de Carvalho Barreto, Ikaro Daniel
Clair RemacreMunareto Lima, Ticiane
Andreline Maia Arcelino, Larissa
Andrade Prado, Luís Flávio
Serra Silveira, Fábio
Augusto da Silva Nascimento, Thiago
Pereira Ferreira, Eduardo José
Vasconcelos Barreto, Rafael
Vieira Moraes, Enilson
Teles de Mendonça, José
Sousa, Antonio Carlos Sobral
Barreto‐Filho, José Augusto
Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
title Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
title_full Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
title_fullStr Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
title_full_unstemmed Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
title_short Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
title_sort disparities in access and mortality of patients with st‐segment–elevation myocardial infarction using the brazilian public healthcare system: victim register
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818046/
https://www.ncbi.nlm.nih.gov/pubmed/31581873
http://dx.doi.org/10.1161/JAHA.119.013057
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