Inequidades e desigualdades no tratamento da coronariopatia aguda: comparação entre rede privada e sistema público de saúde

Abstract

Due to the efforts and commitment of the Brazilian Society of Cardiology, with national regstries, it is possible to have detailed data that allow us to analyze the differences between public and private hospitals in the care provided and outcomes of patients with Acute Coronary Syndrome (ACS). The present investigation aimed to determine the differences in patient characteristics, access to well-equipped services, treatment offered, in-hospital and 12-months outcomes between public and private hospitals in Brazil for patients with Acute Coronary Syndrome. The ACCEPT Registry was a prospective observacional study that included patients hospitalized with a diagnosis of ACS in 47 Brazilian hospitals. Patients were followed from admission to discharge and then followed up by telephone contact at 30 days, 6 months and 12 months. Clinical, personal (previous history) and index event were collected, such as medical prescription and occurrence of major cardiovascular events (cardiovascular mortality, reinfarction and cerebrovascular accident). The current casuistry compared the results obtained by the population using the Brazilian Public Health System and the population using the Private System. Values of p≤0.001 were considered statistically significant. The registry included, from August 2010 to April 2014, a total of 5,047 patients, making it the largest prospective registry ever publised with ACS in Brazil. For the present analysis, all patients who completed the 12-month follow-up (n=4375) were considered. Patients treated in the Public Network had less direct access to a specialized service, and a greater number needed to be transferred (38.9%; p<0.001), in addition to spending more days in the hospital (after 7 days, 40.7% still was hospitalizes; p<0.001) and death (during hospitalization periodo and at 12 months) in this subgroup also presented a statistical difference. It was concluded that, in Brazil, the management of patients with Acute Coronary Syndrome is influenced by the type of care (public or private). Patients had worse outcomes in public hospitals.