Disparidades no acesso às terapias de reperfusão entre pacientes usuários do SUS com IAMCSST residentes na capital e no interior de Sergipe – Estudo VICTIM

Abstract

Background: The cause of disparities in access to treatment for IAMCSST is multifactorial, being related to gender, social class, health coverage and the geographic region of the population. In the state of Sergipe, there is only one hospital with hemodynamics services for users of the Unified Health System (SUS, in Portuguese), located in the capital. It is believed that the centralization of reperfusion therapy in the state is one of the factors that contributes to the delay of patients in the interior when compared to those in the capital. In Brazil, there are no studies comparing the access to reperfusion therapies of patients residing in the capital against in the interior of the states. Objective: To know the disparities of patients with IAMCSST in the access to reperfusion therapies admitted to a hospital with angioplasty from the capital and interior of Sergipe. Methods: The present study is a subanalysis of the VICTIM study, in which 378 patients with STEMI were treated in the period from December 2014 to April 2016 in the four hospitals with the capacity to perform primary angioplasty (AP) in Sergipe. The Pearson χ2 test was used for the association of categorical variables and the Student's t test to evaluate differences in means. Results: The average geographic distance traveled by patients from the interior of Sergipe was 91.57 Km, while those from the capital traveled 21.89 Km to the hospital with hemodynamics (p<0,001). The total interval between the onset of symptoms at the hospital and PCI was 1,659.48 minutes and 1,575.14 minutes for patients in the interior and those in the capital, respectively (p = 0,079). The percentages of chemical reperfusion were low in both groups, only 5.4% of the inland and 1.3% of the capital used fibrinolytics (p = 0,070). Less than half performed primary PCI, only 36.9% of the patients from the interior and 42.9% of the capital performed angioplasty (p = 0.242). Many patients underwent angioplasty for the reperfusion window, 38.9% of patients in the interior and 34.6% of those in the capital (p = 0,449). Conclusion: There is a large gap in prehospital care quality in both spheres, which causes long delays in arriving to the medical service in all municipalities of the state, contributing to the low rate of primary reperfusion in Sergipe.