The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access

Abstract

BackgroundLittle is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality.Methods and resultsUsing data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing.From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.ConclusionsThe majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.

Estatística Cardiovascular – Brasil 2021

“…Nessa avaliação geoespacial nacional do acesso à saúde, mortalidade por SCA foi associada a menor renda, assim como à realização de menor número de exames nucleares e maior número de testes de esforço e de cateterismos cardíacos. 127 • Um estudo usando metodologia de microcusto avaliou os custos associados com ICP em 40 pacientes de dois hospitais públicos de ensino em 2017. O custo mediano de ICP foi R$ 4.579 em um hospital e R$ 3.156 em outro.…”

The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis

“…Easy access to healthcare centers lowers the mortality and morbidity generally [8]. However, some studies have shown that the healthcare resources are unequally distributed across regions in Brazil [9]. Thus, geostatistical tools such as spatial analysis to verify the geographically variance of IHD risks could increase the optimization of healthcare resource allocations [10].…”

Mapping risk of ischemic heart disease using machine learning in a Brazilian state

“…Aging rate was expected to be related to IHD mortality. However, illiteracy and accessibility indexes that are often discussed in scientific literature but not specifying its real importance and weight [ 3 , 7 , 8 ] were important for index formation and can be considered in public policies to reduce mortality. Examples are increasing the number of ambulances as well as the differential management of patients who are more than 120 minutes from the reference hemodynamics centers.…”

“…Brazil had an average of 306 IHD deaths daily, or one death every five minutes [ 2 ]. Cardiac diagnostic tests availability are limited, mostly occurring in urban centers [ 3 ], disproportionately limiting the accessibility of remote population and those from small cities.…”