Author + information
- Bruno Ramos Nascimento,
- Milena Marcolino,
- Luisa Brant,
- Lucas Junqueira,
- Janaina Araujo,
- Luiz Ricardo A. Castro,
- Paula Martins and
- Antonio Ribeiro
Creating evidence-based systems of care for acute myocardial infarction (AMI) aims to optimize patient care, from early diagnosis to appropriate treatment in optimal time frames, in accordance to current guidelines.
To evaluate the effects of an AMI System of Care in a large metropolitan area in Brazil, and its impact on the number of admissions, hospital mortality, access to high complexity medical care and treatment costs.
The AMI System of Care was established in Belo Horizonte in 2010-2011 to increase access for patients of the public health system to the optimal therapy recommended by guidelines. Teams members of emergency units were trained to a flowchart systematic care and these units were equipped with a tele-electrocardiography system. Primary endpoints of this retrospective observational study were the number of hospitalizations due to AMI and AMI hospital mortality rate, from 2009 to 2011.
The city's population in 2009 was 2.452.617. During the study period, 294 professionals were trained and 1496 ECGs were transmitted from emergency units: 563 (37.6%) to coronary care units and 933 (62.4%) to the online diagnoses network. There was a significant decrease in hospital mortality (12.3% in 2009 vs. 9.3% in 2010 vs. 7.1% in 2011, p <0.001), while the number of admissions for AMI remained stable (1113 in 2009 vs. 1358 in 2011, p = NS). There was a significant increase in the average cost of hospitalization (R$ 2480 ± 4054 in 2009 vs. R$ 3501 ± 3202 in 2011, p <0.001), in the proportion of admissions involving intensive care (32.4% in 2009 vs. 66.1% in 2011, p <0.001) and admissions to high complexity units (47.0% vs. 69.6%, p <0.001). Among the patients admitted to intensive care units, mortality reduction was even more substantial (19.7% in 2009 vs. 7.8% in 2011, p < 0.001), and a significant decrease in hospital days (14.4 ± 14.4 in 2009 vs. 12.7 ± 10.0 in 2011, p = 0.022) was observed.
Implementation of the AMI System of Care resulted in easier access to appropriate treatment and, consequently, reduction in hospital mortality from AMI in a large Brazilian urban area. There was also an increase of costs, reflecting the wider access to high complexity medical care.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: AMI and PCI
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1158-99
- 2013 American College of Cardiology Foundation