Abstract 330: Effect of Public and Private Health Insurance on the Access to Invasive-Procedure Hospitals and on the Outcomes in Acute Myocardial Infarction - A Brazilian Pilot Study

• Published in: Circulation Cardiovascular quality and outcomes Vol. 5; no. suppl_1
• Main Authors: Ferreira, Eduardo J, Barreto-Filho, José A, Sousa, Antnio C, Araújo, Lawrence A, Souza-Júnior, Acelino O, Costa, Aelson F, Cunha, Paulo E, Silva, Jose D, Silva-Filho, Claudemir M, Melo, Enaldo V, Oliveira, Joselina L
• Format: Journal Article
• Language: English
• Published: 01.04.2012
• ISSN: 1941-7713; 1941-7705
• DOI: 10.1161/circoutcomes.5.suppl_1.A330

Abstract only Background: In 1988, the public Unique System of Health (SUS) was launched in Brazil with the promise to offer high quality healthcare for all Brazilians and to decrease disparities related to healthcare access and outcomes. Nevertheless, approximately 1/4 of the population use private health services. Whether outcomes of patients with ST-segment elevation myocardial infarction (STEMI) using SUS are similar to those occurring in patients using private services is scarcely known. This study aimed to compare the time of access to PCI hospitals and 30-day mortality in Sergipe, the smallest state in Brazil. Methods: From January to October 2011, we evaluated 143 consecutive patients admitted with diagnosis of STEMI and submitted to PCI in three of the four PCI hospitals in Sergipe, one reference for SUS and the other two receiving patients from the private sector. We investigated the clinical profile, rates of use of drug eluting stents and glycoprotein IIb/IIIa inhibitors and, 30-day mortality among STEMI patients stratified by the health insurance coverage. Results: There were no significant differences in baseline characteristics between groups. Nevertheless, we observed a trend toward increase in incidence of older patients, multivessel disease and/or left main coronary disease in the private group. The time from onset symptoms to arrival at the PCI hospital was above the recommended in both groups but even longer for SUS patients (median, 14 hours, 25 th -75 th percentiles, 8-24 hours) than private patients (median, 7 hours, 25 th -75 th percentiles, 4-17 hours; p=0.003). Nevertheless, door-to-balloon times were similar comparing SUS group (median, 97 minutes, 25 th -75 th percentiles, 79-108 minutes) and private group (median, 90 minutes, 25 th -75 th percentiles, 76-100 minutes; p=0.69). Drug-eluting stents and glycoprotein IIb/IIIa inhibitors were more frequently used in the private group. Despite similar angiographic success rates, younger age and lower prevalence of multivessel disease, SUS patients presented 5% higher 30-day mortality. Conclusions: Our results depicted that STEMI patients using SUS coverage arrived later to PCI hospitals, were less likely to use drug-eluting stent and glycoprotein IIb/IIIa inhibitors and, more importantly, presented higher mortality rates despite lower predicted risk. Our preliminary data suggest disparities related to health insurance coverage and will have potential implications for healthcare policies in Brazil, if we confirm these findings when increasing the sample size.