INFLUENCE OF PUBLIC OR PRIVATE ASSISTANCE IN THE CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

Giulia Bonatto Reichert*1;Cristina Klein Weber, NA2;Marcia Moura Schmidt, Psy.D, PhD2;Mariana Lopes Azeredo1;Bianca De Negri Souza1;Maria Antonieta P. de Moraes, NA2;Carlos Antonio Mascia Gottschall, MD, PhD2 and Alexandre Schaan de Quadros, MD, PhD2, (1)ULBRA, Canoas, Brazil, (2)Instituto de Cardiologia, Porto Alegre, Brazil

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 91

Categories: Outcomes Research, Research Abstracts

Background: Previous studies suggest that the type of healthcare is associated with distinct clinical characteristics and outcomes,  but there are few studies addressing this in patients with a ST-elevation myocardial infarction (STEMI) in our country. 

Methods: Patients presenting to our center from December 2009 to December 2014 were prospectively and consecutively included. The main inclusion criteria was STEMIin the first 12 hours undergoing primary percutaneous coronary intervention (pPCI). Our center is a tertiary cardiology referral center, perfomingmore than 400 pPCIs per year. Clinical charateristics and 2-years follow-up were evaluated by one of the study investigators, and patients from the public vs private health care assistance were compared. 

Results: In the study period, 1,827 patients were included,  75% from public careand 24% fromprivate care. Patients from the public healthcare were  younger and more frequently male, more frequently smokers and with diabetes mellitus, and had  lower education level and lower incomes than patients from the public healthcare. Patients from the public assistance also presented lower rates of dyslipidemia,butthere was no statistical difference in the frequence of hypertension. The  baseline angiographic characteristics and the immediate results of the pPCI procedure were not statistically different. Regarding medical treatment, nitratesand statins were  used more frequentlyin patients from public healthcare, but the use of aspirin and clopidogrel was similar between groups. Enoxaparin, ACE inhibitors and ARBs were prescribed more often for patients treated with private  health insurance, at admission and at discharge. The rates of in-hospital major cardiovascular events were similar between both groups. In the clinical follow-up at 30 days and one year, reinfarction occurred more frequently in  patients from public assisstance, but mortality was similar. 

Conclusions: In a large reference cardiology center in Brazil, patients with STEMI presented distinct clinical characeristics according to the type of insurance, public or private, as of different long-term clinical outcomes. However, there was no difference regarding in-hospital adverse cardiovascular outcomes and results of the pPCI procedure. These discrepancies may suggest a better hospital than ambulatory care in patients with a public healthcare insurance in our country.

To cite this abstract:

Reichert, GB; Weber, CK; Schmidt, MM; Azeredo, ML; Souza, BDN; Moraes, MAPD; Gottschall, CAM; Quadros, ASD . INFLUENCE OF PUBLIC OR PRIVATE ASSISTANCE IN THE CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 91. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/influence-of-public-or-private-assistance-in-the-clinical-characteristics-and-outcomes-of-patients-with-st-elevation-myocardial-infarction/. Accessed September 20, 2019.

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