acs management in low-resource settings/media/non-clinical/files-pdfs... · quality of healthcare...
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Disclosure of Potential Conflicts of Interest
Speaker in meetings sponsored by pharmaceutical
companies
Hold stocks from pharmaceutical companies
Writing of educative materials sponsored by
pharmaceutical companies
Receive institutional support from pharmaceutical
companies
Participate in normative committees of scientific trials
sponsored by pharmaceutical companies
Sponsored in clinical trials and/or in basic research
funded by pharmaceutical companies
Sponsoring of transport and/or hotel accommodations
in Congresses
Company (period from 2002 to 2016)
LIBBS, AstraZeneca, MSD,
Servier,
LIBBS, Novartis, MSD, BMS,
Pfizer, Servier
LIBBS, NovaQuimica,
Servier
Categories of potential conflict of interest
Bayer
–
–
Bayer
ACS Management in Low-Resource Settings
David De Padua Brasil, MD, MSc, FIACS, FICA
FELUMA/CMMG Faculdade de Ciencias Medicas de Minas Gerais,
School of Medicine
Director, Jose Haddad Cardiovascular Investigation Center (CIC),
University Hospital Ciencias Medicas
Belo Horizonte - MG, Brazil
Marcolino MS, Brant LC, Araujo JG, Nascimento BR, Castro LR, Martins P, et al.
Arq Bras Cardiol 2013;100(4):307-14. PubMed PMID: 23545995.
Characteristics of ACS Healthcare Assistance in the Metropolitan Area of
Belo Horizonte, MG - Brazil - Retrospective Observational Study
Quality Criteria Assessment
Nascimento BR, et al. Arq Bras Cardiol, 2016
71st Brazilian Congress of Cardiology 2016
“Quality of Healthcare Evaluation in Patients with
Myocardial Infarction Admitted in the Coronary
Care Unit of Hospital of Clinics, UFMG”
Measures of quality were performed according to
the ACC/AHA 2008 Performance Measures for
Adults With ST-Elevation and Non–ST-Elevation
Myocardial Infarction
Admission Chart for Social-Insured AMI Patients
SUS - Unified Healthcare System - Belo Horizonte, MG - Brazil
6 UPAs• Barreiro
• Nordeste
• Norte
• Oeste
• Pampulha
• Venda Nova
Demographic Characteristics STEMI NSTEMIN=788 (69.8) N=341 (30.2)
Age (years) 59 (51-67) 62 (54-72)
Gender - absolute number (%)
Male 544 (69) 221 (64.8)
Female 244 (31) 120 (35.2)
Ethnicity - absolute number (%)
Caucasian 300 (38.1) 144 (42.2)
Asiatic 6 (0.8) 4 (1.2)
Black 109 (13.8) 40 (11.7)
Mixed 285 (36.2) 125 (36.7)
Not reported 88 (11.2) 28 (8.2)
Origin
ER - Hospital of Clinics 21 (2.7) 30 (8.8)
Units of Urgency/Emergency Care UPAs 193 (24.5) 74 (21.7)
Various hospitals in Belo Horizonte 169 (21,4) 109 (32)
ERs - Metropolitan Area of Belo Horizonte 319 (40.5) 88 (25.8)
ERs - Other cities an towns 74 (9.4) 30 (8.8)
Not identified 12 (1.5) 10 (2.9)
Demographic Characteristics of Patients with STEMI and NSTEMI
Quality of Healthcare in Patients Admitted in the
CCU of Hospital of Clinics - UFMG - Belo Horizonte
Nascimento BR, et al. Arq Bras Cardiol, 2016
71st Brazilian Congress of Cardiology 2016
Clinical Characteristics STEMI NSTEMI
N=788 (69.8) N=341 (30.2)
Clinical Features - absolute number (%)
Killip I 490 (62.2) 239 (70.1)
Killip II 175 (22.2) 67 (19.6)
Killip III 39 (4.9) 25 (7.3)
Killip IV 84 (10.7) 10 (2.9)
Previous history
Hypertension 523 (66.4) 273 (80.1)
Diabetes Mellitus 190 (24.1) 107 (31.4)
Dyslipidemia 347 (44) 194 (56.9)
Smoking 344 (43.7) 94 (27.6)
Family history of early CAD 186 (23.6) 86 (25.2)
AMI 59 (7.5) 86 (25.2)
PTCA 11 (1.4) 26 (7.6)
CABG 8 (1) 10 (2.9)
Cerebrovascular Disease 42 (5.3) 15 (4.4)
Clinical Characteristics of Patients with STEMI and NSTEMI
Quality of Healthcare in Patients Admitted in the
CCU of Hospital of Clinics - UFMG - Belo Horizonte
Nascimento BR, et al. Arq Bras Cardiol, 2016
71st Brazilian Congress of Cardiology 2016
Adherence to AHA/ACC Quality Criteria in Patients with STEMI and NSTEMI
Quality of Healthcare in Patients Admitted in the
CCU of Hospital of Clinics - UFMG - Belo Horizonte
Quality Criteria STEMI NSTEMIN= 788 (69.8) N= 341 (30.2)
Door to Needle Time < 30 minutesYes 36 (13.6)No 228 (86.4)Not Applicable 524 341
Door to Balloon Time < 90 minutesYes 128 (75.3)No 42 (24.7)Not Applicable 618 341
Reperfusion Therapy (chemical thrombolysis)Yes 400 (56.0)No 314 (43.1)Not Applicable 74 341
Time since arrival at the ER + Time until arrival at referring hospital for primary PTCA < 60 minutesYes 10 (5.2)No 181 (94.8)Not Applicable 597 341
Time since arrival at the ER + Time until balloon inflation < 120 minutesYes 7 (4.2)No 159 (95.8)Not Applicable 622 341
Nascimento BR, et al. Arq Bras Cardiol, 2016. 71st Brazilian Congress of Cardiology 2016
Time Intervals in the Referral (transfer) of STEMI Patients
Quality of Healthcare in Patients Admitted in the
CCU of Hospital of Clinics - UFMG - Belo Horizonte
TIME (minutes) Minimum1st
QuartileMedian
3rd
QuartileMaximum
From Admission to Thrombolytic Therapy
in the UPAs 0 60 100 176.25 2424
From Admission in the UPAs
Until Arrival at HC 50 180 270 390 1020
From Admission in the UPAs
Until Balloon Inflation at HC 80 234 352 501 1072
From Arrival at HC
Until Balloon Inflation at the Cath Lab 10 40 66 90 715
HC: Hospital of Clinics (tertiary university hospital; UFMG: Federal University of Minas Gerais
Nascimento BR, et al. Arq Bras Cardiol, 2016
71st Brazilian Congress of Cardiology 2016
Quality of Healthcare in Patients Admitted in the
CCU of Hospital of Clinics - UFMG - Belo HorizonteIndependent Variables Associated with Adherence to the
AHA/ACC Quality Measures for AMI (>80% of criteria were applicable)
Multivariate Regression Model
Variable OR 95% CI p-value
Gender (male) 1.33 1.01-1.76 0.046*
Killip Class I or II (at admission) 1.95 1.36-2.80 <0.001*
Diagnosis of NSTEMI 5 3.51-7.12 <0.001*
Date of admission with AMI
in the referral system (Belo Horizonte/Semester) 1.19 1.10-1.28 <0.001*
OR: Odds-ratio; CI: 95% confidence interval ; *p < 0.005
Nascimento BR, et al. Arq Bras Cardiol, 2016
71st Brazilian Congress of Cardiology 2016
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