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. 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.
['Oliveira|Jussiely Cunha|JC|', 'Almeida-Santos|Marcos Antonio|MA|', 'Cunha-Oliveira|Jeferson|J|', 'Oliveira|Laís Costa Souza|LCS|', 'de Carvalho Barreto|Ikaro Daniel|ID|', 'Clair RemacreMunareto Lima|Ticiane|T|', 'Andreline Maia Arcelino|Larissa|L|', 'Andrade Prado|Luís Flávio|LF|', 'Serra Silveira|Fábio|F|', 'Augusto da Silva Nascimento|Thiago|T|', 'Pereira Ferreira|Eduardo José|EJ|', 'Vasconcelos Barreto|Rafael|R|', 'Vieira Moraes|Enilson|E|', 'Teles de Mendonça|José|J|', 'Sousa|Antonio Carlos Sobral|ACS|', 'Barreto-Filho|José Augusto|JA|', '|||']
D001938:Brazil D005260:Female D005500:Follow-Up Studies D006297:Health Services Accessibility D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D011379:Prognosis D011446:Prospective Studies D011634:Public Health D012042:Registries D012307:Risk Factors D000072657:ST Elevation Myocardial Infarction D015996:Survival Rate D013997:Time Factors D061665:Time-to-Treatment
acute myocardial infarction health disparities health policy and outcomes research health services coverage