A influência do plano de saúde na evolução a longo prazo de pacientes com infarto agudo do miocárdio

Nicolau, José Carlos; Baracioli, Luciano Moreira; Serrano, Carlos; Giraldez, Roberto R.; Filho, Roberto Kalil; Lima, Flávia Gontijo de; Franken, Marcelo; Ganem, Fernando; Lage, Rony L.; Truffa, Rodrigo

doi:10.1590/s0066-782x2008001800004

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…Similar to our findings, Nicolau et al [ 11 ] compared the mortality rates during and after hospital admission in patients with acute myocardial infarction who benefited from the private or the public healthcare system. These authors demonstrated that the public healthcare patients exhibited the same in-hospital mortality rate (10.3% versus 11.4%; P = 0.5) but also exhibited an increased chance of long-term mortality (36% higher odds; P = 0.005) compared with the private healthcare patients.…”

Section: Discussionsupporting

confidence: 90%

“…Patients who use the public healthcare system are more likely to have less education and income. These factors, in association with a poor organizational health structure, could limit the access of ICU survivors to healthcare [ 11 ]. An Australian cohort of 15619 critically ill patients demonstrated that those with the worst SEC were also younger and had more severe conditions and that the long-term mortality among this group was also higher despite the in-hospital mortality of these patients being similar to the patients with better SEC [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes

Neto

Rosa

Duso

et al. 2016

BioMed Research International

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Purpose. The long-term outcomes of patients after discharge from tertiary ICUs as they relate to the public versus private healthcare systems in Brazil have not yet been evaluated. Materials and Methods. A multicenter prospective cohort study was conducted to compare the all-cause mortality and the physical functional status (PFS) 24 months after discharge from the ICU between adult patients treated in the public and private healthcare systems. A propensity score- (PS-) matched comparison of all causes of mortality and PFS 24 months after discharge from the ICU was performed. Results. In total, 928 patients were discharged from the ICU including 172 (18.6%) patients in the public and 756 (81.4%) patients in the private healthcare system. The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%, P = 0.003). The comparison of the PS-matched Karnofsky performance and Lawton activities of daily living scores between the ICU survivors of the public and private healthcare systems revealed no significant differences. Conclusions. The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes

Neto

Rosa

Duso

et al. 2016

BioMed Research International

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“…26, 27 Moreover, work in other countries has suggested that patients enrolled in public health care plans may not fare as well as patients who are privately insured. 28 However, these studies either did not distinguish between effects due to payer status and effects due to SES, nor they did not control for risk factors commonly associated with low SES. Since payer status and SES tend to be highly correlated, this represents an important confounding factor.…”

Section: Discussionmentioning

confidence: 99%

Primary Payer Status Is Associated With Mortality and Resource Utilization for Coronary Artery Bypass Grafting

et al. 2012

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Background Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following coronary artery bypass grafting (CABG) in the United States is dependent upon primary payer status. Methods From 2003–2007, 1,250,619 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were stratified by primary payer status: Medicare, Medicaid, Uninsured, and Private Insurance. Hierarchical multiple regression models were applied to assess the effect of primary payer status on postoperative outcomes. Results Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%) and Uninsured (1.9%) patients were higher compared to Private Insurance patients (1.1%, p<0.001). Unadjusted length of stay was longest for Medicaid patients (10.9±0.04 days) and shortest for Private Insurance patients (8.0±0.01 days, p<0.001). Medicaid patients accrued the highest unadjusted total costs ($113,380±386, p<0.001). Importantly, after controlling for patient risk factors, income, hospital features, and operative volume, Medicaid (OR=1.82, p<0.001) and Uninsured (OR=1.62, p<0.001) payer status independently conferred the highest adjusted odds of in-hospital mortality. In addition, Medicaid payer status was associated with the longest adjusted length of stay and highest adjusted total costs (p<0.001). Conclusions Medicaid and Uninsured payer status confers increased risk adjusted in-hospital mortality for patients undergoing coronary artery bypass grafting operations. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors. Possible explanations include delays in access to care or disparate differences in health maintenance.

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“…Epidemiological data from major societies point cardiovascular diseases as those with increased mortality and morbidity [1,2]. There is expectation that in 2020, 40% of deaths are related to them.…”

Section: Introductionmentioning

confidence: 99%

Time of arrival of patients with acute myocardial infarction to the emergency department

Bastos¹,

Beccária²,

Contrin³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Objectives: To characterize the profile of patients with acute myocardial infarction (AMI) treated at the emergency department and to verify the time of arrival of each patient (∆T). Identify how the patient was transported and to correlate Delta-T (∆T) with the treatment and the prognosis of each patient.Methods: Cross-sectional survey involving 52 patients with AMI admitted to the Emergency Department of a Teaching Hospital took part in the study from July to December 2010. Data collection was performed using medical records and interviews.Results: The majority of the patients were male with a mean age of 62.35 ± 14.66 years. The participants were married, with low education levels, family history of heart diseases, arterial hypertension, dyslipidemia, and a sedentary lifestyle. The symptoms presented were pains in the chest, epigastric region, or a chest discomfort associated to dyspnea and/or sudden sweating. The majority of the patients were transported by ambulance. They were submitted to cardiac catheterization followed by angioplasty. Delta-T found was 9h45min ± 18h9min. In this study, the overall lethality was 3.85%.Conclusions: The perception of signs and symptoms of AMI by the patient was a decisive factor when seeking out specialized treatment. Those with the lowest Delta-T presented better prognosis. Descriptors

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A influência do plano de saúde na evolução a longo prazo de pacientes com infarto agudo do miocárdio

Abstract: SummaryBackground: Little is known, especially in our country, about the influence of health insurance plans on the long term outcome of patients after acute myocardial infarction (AMI).

Cited by 3 publications

References 11 publications

Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes

Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes

Primary Payer Status Is Associated With Mortality and Resource Utilization for Coronary Artery Bypass Grafting

Time of arrival of patients with acute myocardial infarction to the emergency department

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