Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network - VICTIM Register

Abstract

Background Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

Brazil: Two Realities for the Treatment of One Disease

“…In this study VICTIM Oliveira et al, 13 analyzing the incorporation of DES in public and private institutions in the State of Sergipe (between 2014 and 2017; after the approval of its use in Brazil's public health system [SUS] at the amount of BRL 2,034.50), found that only 8.7% of diabetic patients with STEMI were treated with DES in the public system, while 90.6% received DES in the private healthcare system. These figures make evident the worrying reality of the Brazilian public health system regarding the treatment of STEMI, especially in a vulnerable population such as diabetics.…”

Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022

“… 145 The socioeconomic level results in higher vulnerability of access for low-income women, which could cause higher short-term mortality in ACS. 146 …”

“… 145 O status socioeconômico coloca a mulher de baixa renda em maior vulnerabilidade para acesso, o que poderia acarretar maior mortalidade a curto prazo após quadro de SCA. 146 …”

“…As mulheres apresentaram menores taxas de fibrinólise (2,3% no total, 1,7% nas mulheres e 2,6% nos homens) e de angioplastia primária (44% nas mulheres e 54,5% nos homens), resultando em maior mortalidade hospitalar (16,1% versus 6,7%). 146 …”

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

“…As mulheres apresentaram taxas significativamente menores de angioplastia primária (44% versus 54,5%; p = 0,003) e significativamente maiores de mortalidade hospitalar (16,1% versus 6,7%; p < 0,001) do que os homens. 38 Outro estudo unicêntrico prospectivo realizado em Recife com 709 pacientes consecutivos com IAMCSST (36% de mulheres; média de idade, 61 anos), no período de fevereiro de 2018 a fevereiro de 2019, observou que as mulheres eram mais velhas (63,13 anos versus 60,53 anos, p = 0,011), mais frequentemente apresentavam HAS (75,1% versus. 62,4%, p = 0,001), DM (42,2% versus 27,8%, p < 0,001) e dislipidemia (34,1% versus 23,9%, p= 0,004), além de serem menos submetidas à intervenção coronariana percutânea (ICP) por acesso radial (23,7% versus 46,1%, p < 0,001) do que os homens.…”