Abstract 12536: Inequities and Outcomes for Patients With ST-Segment Elevation Myocardial Infarction in Brazil - Insights From The ACCEPT Registry
The public Unified Health System (SUS) was launched in Brazil with the promise to decrease inequities. Whether outcomes of patients with ST-segment elevation myocardial infarction (STEMI) using SUS are similar to those occurring in patients covered by private health insurance (PHI) is unknown.
We used the ACCEPT registry (Acute Coronary Care Evaluation of Practice Registry), the largest Brazilian registry for this condition, to compare outcomes for STEMI in users of SUS (n=497) and PHI (n=303). From 2010 to 2011, 47 volunteer centers, representing all Brazilian regions, enrolled 800 patients admitted with the primary diagnosis of STEMI and followed-up for 30 days from the event. We investigated clinical profile, rates of use of primary PCI, thrombolysis, drug eluting stents, revascularization procedures after the acute phase(PCI or CABG) and, 30-day cardiovascular events defined as reinfarction, stroke, cardiac arrest, cardiac death and major bleeding among STEMI patients stratified by their health insurance coverage. In addition, we investigated the use of evidence based medical treatment at 30 days post STEMI.
Compared with PHI patients, SUS patients were younger (p≤0.001), less likely to refer history of MI (p=0.01), stroke (p=0.03) or heart failure (p≤0.001), characterizing a population with less morbidity. Primary PCI (71 vs 87%; p≤0.001), drug eluting stents (1.2 vs 37.1%; p≤0.001), aspirin (91.4 vs 95.7%; p=0.03), clopidogrel (75.7 vs 86.4%; p≤0.001), prasugrel (0.2 vs 2.3%; p=0.01) were less likely used for SUS patients. Conversely, thrombolytics (8 vs 3%; p≤0.001) and transradial approach (42.7 vs 13.3 %; p≤0.001) were less likely used for PHI patients. No differences were noticed comparing the incidence of reinfarction, stroke and major bleeding in SUS and PHI users. Nevertheless, cardiac arrest (5.3% vs 2%; p≤0.03) and cardiac death (6% vs 1.3 %; p≤0.001) occurred more frequently in SUS patients.
Our results reveal inequities in the process of care and outcomes with respect to health insurance coverage. Although SUS patients were younger and less morbid than PHI patients, their 30-day mortality was higher. Our data may have potential implications for designing a more equitable healthcare system in Brazil.
- © 2013 by American Heart Association, Inc.