Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos / The impact of Chilean health reform in the management and mortality of ST elevation myocardial infarction (STEMI) in Chilean hospitals
Rev. méd. Chile
;
136(10): 1231-1239, Oct. 2008. ilus, tab
Article
in Spanish
| LILACS
| ID: lil-503889
ABSTRACT
Background:
In 2005 the Chilean government started a health care reform (AUGE) that guarantees medical treatment for acute myocardial infarction.Aim:
To quantify the impact ofAUGE on the management and inhospital mortality of STEMI in a group of Chilean hospitals. Material andmethods:
Three thousand five hundred and forty six patients with STEMI from 10 hospitals that perform thrombolysis as the main reperfusion therapy were analyzed. We compared demographic and clinical characteristics, hospital treatments and revascularization proceduresin two periods before (2,623 patients) and after AUGE implementation (906 patients). Logistic regression was used to assess inhospital mortality according to AUGE in the entire sample and stratified by risk groups.Results:
We found no differences in demographic and clinical characteristics between the two groups. During AUGE threre was a significant increase in the use of thrombolysis (50 percent to 60.5 percent), which was associated to an increase of hypotension from 29 percent to 35 percent (p <0.02) and minor bleedings, from 1.6 percent to 3.4 percent (p <0.001). After A UGE there was a significant increase in the use ofbeta blockers (65 percent to 75 percent), angiotensin converting enzyme inhibitors (70 percent to 76 percent), statins (48 percent to 58 percent), and aspirin (96 percent to 97.5 percent) (p <0.05). Global inhospital mortality decreased from 12.0 percent to 8.6 percent (p <0.003) and from 10.6 percent to 6.8 percent (p <0.005) in patients treated with thrombolytics. The adjusted odds ratio for inhospital mortality comparing after and before AUGE, was 0.64 (IC 95 percent, 0,47-0.86).Conclusions:
The implementation ofAUGE has been successful in reducing inhospital mortality of STEMI This has been achieved through a better use of evidence based medicine and reperfusion strategies.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Delivery of Health Care
/
Health Plan Implementation
/
Hospitalization
/
Myocardial Infarction
Type of study:
Controlled clinical trial
/
Systematic review of observational studies
Limits:
Female
/
Humans
/
Male
Country/Region as subject:
South America
/
Chile
Language:
Spanish
Journal:
Rev. méd. Chile
Journal subject:
Medicine
Year:
2008
Type:
Article
Affiliation country:
Chile
Institution/Affiliation country:
Asistencia Pública/CL
/
Hospital San Juan de Dios/CL
/
Pontificia Universidad Católica de Chile/CL
/
Universidad de Chile/CL
/
Universidad de La Frontera/CL
/
Universidad de Los Andes/CL
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