Disparidades no acesso e na sobrevida em longo prazo de pacientes com infarto agudo do miocárdio do serviço público e privado de saúde: registro VICTIM EXTENDED

Abstract

Disparities in access and long-term survival of patients with acute myocardial infarction in public and private health services: Registry VICTIM Extended. Ticiane Clair Remacre Munareto Lima. 2023. Introduction: In regions with great socioeconomic disparities, little is known about the prognosis of long-term survival of patients after Acute Myocardial Infarction with ST Segment Elevation (STEMI), which are essential data to assist in the therapeutic decision of AMI and guide the allocation of public resources. Objective: To evaluate the impact of disparities in access to specialized services and reperfusion therapies on long-term survival in patients with STEMI in public (SUS) and private health services. Methods: Cohort study, with STEMI patients from the Via Crucis registry for the Treatment of Myocardial Infarction (VICTIM). Clinical, sociodemographic and access data collected in four hospitals, one public and three private, from 2014 to 2018, and long-term survival was investigated through telephone interviews, from January 2020 to February 2021. Kaplan-Meier survival curves and Cox regression were used to evaluate survival data, with a significance level of p<0.05 and a 95% confidence interval. Results: Of the 1,082 patients, 893 (82.53%) were treated by the SUS and 189 (17.47%) by the private service. SUS patients had to travel six times longer from the place where the pain started to the PCI hospital (58.2 km vs. 8.7 km; p<0.001); had lower reperfusion rates (49.8% vs. 67.2%; p<0.001) and primary PCI (47.2% vs. 66.5%; p<0.001); and they often had to pass through at least one institution before reaching the PCI unit hospital (76.1% vs. 41%; p<0.001). The time from the onset of symptoms to seeking help was similar in both groups, but the overall time from the onset of symptoms to arrival at the PCI service hospital was longer for SUS patients (10.3h vs. 5.3h; p<0.001). Fibrinolytic therapy was underused in both services (2.5% vs. 1.1%; p=0.411). In the fully adjusted model, the risk of long-term mortality for SUS patients was higher (HR, 1.64; 95% CI, 1.10 to 2.46; p=0.015). When stratified by type of service and reperfusion, the risk of long-term mortality for SUS patients who did not undergo reperfusion was significantly higher than the other groups (HR, 2.08, 95% CI, 1.20 to 3. 61; p=0.009). Conclusion: SUS patients were more likely to die in the long term, had less access to reperfusion therapies and later access to specialized services, which indicates a disparity by type of health service.