Maior letalidade e morbidade por infarto agudo do miocárdio em hospital público, em Feira de Santana - Bahia

Abstract

SummaryBackground: Factors related to socioeconomic status and health care quality and management may influence mortality and morbidity rates due to acute myocardial infarction (AMI).Objective: To compare mortality and morbidity in patients with AMI hospitalized in public and private hospitals.Methods: An observational study, with comparison groups. Clinical evaluation on admission, and recording of diagnostic, therapeutic and evolution data until discharge or death. Comparison of clinical characteristics by univariate analysis followed by bivariate analysis, evaluating the combination of predictors with death and morbidity (Killip> I), SPSS, version 13.0. Results IntroductionAcute myocardial infarction (AMI) is the main complication of CAD 1 . The mortality and morbidity from AMI depends on factors related to the severity of the disease and the speed and quality of hospital care. If the patient receives appropriate hospital care within few hours after onset of the symptoms, the mortality worldwide is around 10% 2, similar to that observed in the hospitals of the cities of Rio de Janeiro (10.8%) and Niterói (12.3%) 3,4 . However, this percentage may not reflect the reality when there are factors such as delay between the onset of pain and arrival at the hospital, delay in the start of in-hospital treatment, restrictions on the use of myocardial protection measures, such as primary angioplasty and thrombolytics, and on access to intensive care unit 2,5 . In addition, the social strata of lower income and education show a more serious natural history of CAD, with the possibility of higher mortality and morbidity in the first 28 days post-AMI 6,7 . Although the reasons for this are not well defined, it is noteworthy that public health care units, such as hospitals and health care centers, do not always have a specialized staff for emergency cardiovascular care, there is scarcity of certain drugs, such as thrombolytics, and there are insufficient number of beds in ICU to meet local demand, and these are issues that have an important influence on the prognosis of the disease. Other factors like limited access to a specialized hospital or outpatient care unit of better quality, and limitations on the maintenance of appropriate preventive measures of primary or secondary type have also been considered 5-7 .In Bahia, there are serious limitations on high complexity cardiovascular care in the public system, which needs to be reviewed, aiming at a recasting of the system. The city of Feira de Santana, with 600,000 inhabitants, the largest city of inland Bahia State, has only one public hospital and three private hospitals with intensive care units, where all the cardiological care of the region takes place, creating favorable conditions for the study of these issues. Therefore, the assessment of the mortality and morbidity in the hospital phase of AMI, the coronary risk profile of public and private patients, and the quality of health care in that city can provide relevant data to help correct these serious distortions i...

Acesso de usuários com infarto do miocárdio a hospitais referência em cardiologia

“…Most participants suffered infarction with ST-segment elevation similar to the proportion recorded by Ferreira et al (2009). Among those with this type of infarction, only 12% were reperfused.…”

Os dois Brasis e o tratamento do infarto agudo do miocárdio

“…This rate was four times higher than that found among those who were hospitalized in the three private hospitals in the same city (4.8%, p = 0001) 4 . The patients who were hospitalized in the public hospital were predominantly poor and illiterate, they took more time to get to the hospital and to be medicated, and evolved with greater severity, which resulted in a high frequency of patients in Killip class II or higher.…”

“…In-hospital mortality fell from an alarming rate of 30-40%, in the 50s and 60s 2 , to less than 5%, in 2006 3 , thanks to the introduction of several therapeutic strategies, among which we highlight the opening of cardiovascular intensive care units (ICU), the coronary units, and the introduction of chemical or percutaneous reperfusion therapy 1 . The article published in this volume of the Archives, however, shows that the benefits of modern treatment of AMI are not accessible to all Brazilians 4 .…”

“…The patients who were hospitalized in the public hospital were predominantly poor and illiterate, they took more time to get to the hospital and to be medicated, and evolved with greater severity, which resulted in a high frequency of patients in Killip class II or higher. The treatment was also radically different: while 94% of those seen in the private hospitals received treatment in the ICU, with the use of thrombolytics in 79% of them, only 8% of the public hospital patients were admitted to the ICU, and 21% of them were submitted to reperfusion therapy 4 . Beta blockers, independent predictors of prognosis in this sample, were more often used in private hospitals.…”

“…One of the most conspicuous results of the study conducted by Ferreira et al 4 was the magnitude of the difference in mortality between private and public hospitals, which is directly linked to differences in the use of acknowledgedly effective measures for the treatment of myocardial infarction. The descriptions of the deaths documented at public hospitals reveal that many could have been avoided by continuous monitoring in the ICU: five of the 17 fatal cases in the public hospital occurred due to sudden death and ventricular arrhythmia.…”