Chilean mortality due to STEMI: analysis of a public policy using interrupted time series

Abstract

Issue To the end of 1990s, ST-segment elevation myocardial infarction (STEMI), along with other causes, led the causes of death in Chile. Therefore, at the beginning of 2000s, the explicit health guarantees policies were created, including the treatment of STEMI, which was implemented in first quarter of 2005, generating a series of benefits that seek to improve people's survival. However, there are few studies that show the effectiveness of interventions at the level of morbimortality, given the difficulty in database (DB) collection. Description of the problem The objective is to determine if the policy implemented was able to reduce the mortality associated for STEMI, evidenced in the number of cases and potential years of life lost (PYLL). The public DB of Hospital Discharges (HD) and Deaths of Chile during the periods 1997-2017 were analyzed. ICD-10 codes were identified for STEMI. An interrupted time series analysis (ITSA) was performed with Newey-West regression adjusted according to autocorrelation, using as intervention the start of the STEMI policy, both in annual and quarterly series. For PYLL calculation, life expectancies by sex, were used, available on the website of the National Institute of Statistics of Chile. The data was analyzed with Stata v15.1. Results 27807004 HD were recorded, of which 143061 were due to STEMI, 10.9% died at the in-hospital. Regarding deaths, 1586731 occurred, of which 6.37% were secondary to STEMI. When performing ITSA, for deaths it was observed that there was a significant increase in post-intervention cases (p-value <0.05), PYLL increased post intervention (p-value 0.001). HD showed a decrease in post-intervention mortality cases (p-value <0.01) and PYLL showed no significative changes with respect to the pre-intervention time. Lessons Globally, the focus on treatment has not allowed to reduce STEMI mortality. Prevention is the key to treat Social Transmission Diseases Key messages ITSA is a powerful tool to analyze interventions. Prevent and treat.