Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública

Caluza, Ana Christina Vellozo; Barbosa, Adriano Henrique Pereira; Gonçalves, Iran; Oliveira, Carlos Alexandre Lemes de; Matos, Lívia Nascimento de; Zeefried, Claus; Moreno, Antônio Célio Camargo; Tarkieltaub, Elcio; Alves, Cláudia Maria Rodrigues; Carvalho, Antônio Carlos

doi:10.1590/s0066-782x2012005000100

Cited by 40 publications

(21 citation statements)

References 29 publications

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“…In Brazil specifically, acute coronary syndromes are the third ranking cause of hospitalization, and mortality rates of 15% to 20% following ST‐segment–elevation acute myocardial infarction (STEMI) have been reported 3, 4. Large gaps in STEMI care remain in Brazil.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)

Filho

Solla³

et al. 2018

JAHA

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BackgroundFew data exist on regional systems of care for the treatment of ST‐segment–elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30‐day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil.Methods and ResultsFrom January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6‐month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%–53.8%; P<0.001), and more patients were transferred to the referral center (44.7%–76.3%; P=0.001). Thirty‐day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30‐day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy.ConclusionsImplementation of a regional STEMI system was associated with lower mortality and higher use of evidence‐based therapies.

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Section: Introductionmentioning

confidence: 99%

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)

Filho

Solla³

et al. 2018

JAHA

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“…In addition, the response level of the emergency services has been insufficient, as highlighted in the Municipal Health Plan 2014-2017. Although these services aim to respond rapidly to the users and to counter-refer them to the other points in the healthcare network, (22) they face challenges in the work process, such as the overload of care in response to spontaneous demand in the primary health care services, diminished health teams, disarticulated work process, scrapping of the physical structure and referral and counter-referral difficulties.…”

Section: Discussionmentioning

confidence: 99%

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

et al. 2016

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Objective: To analyze the access times of men and women who are having a myocardial infarction to referral hospitals in cardiology and the correlation between them. Methods: Cross-sectional research, involving 100 victims of a myocardial infarction who were interviewed at referral hospitals in cardiology. To analyze the data, descriptive and inferential statistics were used with statistical significance. Results: The access times were long (decision to seek care, arrival to first health service, time in care network and admission to referral hospitals in cardiology), except for the transportation time, mainly for women. The decision time contributed more to the time it took to arrive at the first health service and the time in the care network contributed more to the time to arrive at the referral hospitals in cardiology. Conclusion: The long time waiting for specialized care reflects the lack of structure of the health services and the long decision time reflects the participants' lack of recognition of the myocardial infarction. ResumoObjetivo: Analisar os tempos relacionados ao acesso de homens e mulheres com infarto do miocárdio a hospitais referência em cardiologia e a correlação entre eles. Métodos: Pesquisa transversal, com 100 pessoas com infarto entrevistadas em hospitais referência em cardiologia. Dados analisados por estatística descritiva e inferencial, adotando-se significância estatística. Resultados: Os tempos foram elevados (decisão para atendimento, chegada ao primeiro serviço de saúde, permanência na rede de atenção e admissão em hospitais referência em cardiologia), exceto o de transporte, sobretudo para mulheres. Houve maior contribuição do tempo de decisão na composição do tempo de chegada ao primeiro serviço de saúde e do tempo de permanência na rede na composição do tempo de chegada aos hospitais referência em cardiologia. Conclusão: A longa espera por atenção especializada reflete a falta de estrutura dos serviços de saúde, e o tempo de decisão elevado reflete a falta do não reconhecimento do infarto pelos participantes. KeywordsHealth services accessibility; Public health nursing; Education, nursing; Myocardial infarction Descritores Acesso aos serviços de saúde; Enfermagem em saúde pública; Educação em enfermagem; Infarto do miocárdio

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“…Another limitation is the profile of the centers contributing to the data bank, 90% of which are tertiary hospitals with hemodynamic laboratories 11 , known to have greater adherence to guidelines 19,23 . The contribution to the ACCEPT registry of centers with fewer resources is important to provide a real image of the quality of the care provided to the Brazilian population; thus, the implantation of new health care models, with draining systems from primary to more complex centers, in several Brazilian cities should be considered 24,25 .…”

Section: Discussionmentioning

confidence: 99%

Use of Evidence-Based Interventions in Acute Coronary Syndrome - Subanalysis of the ACCEPT Registry

Wang¹,

Neuenschwander²,

Filho³

et al. 2014

Arquivos Brasileiros De Cardiologia

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BackgroundThe recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice.ObjectiveTo describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil.MethodsThis study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated.ResultsThis study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times.ConclusionThis registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended.

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Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública

Abstract: Background: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles.

Cited by 40 publications

References 29 publications

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

Use of Evidence-Based Interventions in Acute Coronary Syndrome - Subanalysis of the ACCEPT Registry

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