Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

Detalhes bibliográficos
Autor(a) principal: Escosteguy,Claudia Caminha
Data de Publicação: 2001
Outros Autores: Portela,Margareth Crisóstomo, Vasconcellos,Maurício Teixeira Leite de, Medronho,Roberto de Andrade
Tipo de documento: Artigo
Idioma: eng
Título da fonte: São Paulo medical journal (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802001000600003
Resumo: CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS) in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS) with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2). 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4). The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0). Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9) of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6); beta-blockers in 49.0% (95% CI 43.8 to 54.1); angiotensin-converting enzyme (ACE) inhibitors in 63.3% (95% CI 58.2 to 68.1); nitrates in 82.0% (95% CI 82.4 to 89.6); heparin in 81.3% (95% CI 76.9 to 85.0); calcium antagonists in 30.5% (95% CI 26.0 to 35.4). There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and intravenous nitrates). The use of calcium antagonists, not supported by scientific evidence in acute myocardial infarction, was quite frequent. A logistic model documented the benefit of aspirin, beta-blockers and ACE inhibitor use in reducing the chance of hospital death.
id APM-1_3580e447296af35c95881cc52d61bb1c
oai_identifier_str oai:scielo:S1516-31802001000600003
network_acronym_str APM-1
network_name_str São Paulo medical journal (Online)
repository_id_str
spelling Pharmacological management of acute myocardial infarction in the municipal district of Rio de JaneiroAcute myocardial infarctionHealthcare assuranceQuality assuranceThrombolytic therapyCONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS) in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS) with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2). 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4). The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0). Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9) of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6); beta-blockers in 49.0% (95% CI 43.8 to 54.1); angiotensin-converting enzyme (ACE) inhibitors in 63.3% (95% CI 58.2 to 68.1); nitrates in 82.0% (95% CI 82.4 to 89.6); heparin in 81.3% (95% CI 76.9 to 85.0); calcium antagonists in 30.5% (95% CI 26.0 to 35.4). There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and intravenous nitrates). The use of calcium antagonists, not supported by scientific evidence in acute myocardial infarction, was quite frequent. A logistic model documented the benefit of aspirin, beta-blockers and ACE inhibitor use in reducing the chance of hospital death.Associação Paulista de Medicina - APM2001-11-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802001000600003Sao Paulo Medical Journal v.119 n.6 2001reponame:São Paulo medical journal (Online)instname:Associação Paulista de Medicinainstacron:APM10.1590/S1516-31802001000600003info:eu-repo/semantics/openAccessEscosteguy,Claudia CaminhaPortela,Margareth CrisóstomoVasconcellos,Maurício Teixeira Leite deMedronho,Roberto de Andradeeng2001-11-27T00:00:00Zoai:scielo:S1516-31802001000600003Revistahttp://www.scielo.br/spmjhttps://old.scielo.br/oai/scielo-oai.phprevistas@apm.org.br1806-94601516-3180opendoar:2001-11-27T00:00São Paulo medical journal (Online) - Associação Paulista de Medicinafalse
dc.title.none.fl_str_mv Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
title Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
spellingShingle Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
Escosteguy,Claudia Caminha
Acute myocardial infarction
Healthcare assurance
Quality assurance
Thrombolytic therapy
title_short Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
title_full Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
title_fullStr Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
title_full_unstemmed Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
title_sort Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
author Escosteguy,Claudia Caminha
author_facet Escosteguy,Claudia Caminha
Portela,Margareth Crisóstomo
Vasconcellos,Maurício Teixeira Leite de
Medronho,Roberto de Andrade
author_role author
author2 Portela,Margareth Crisóstomo
Vasconcellos,Maurício Teixeira Leite de
Medronho,Roberto de Andrade
author2_role author
author
author
dc.contributor.author.fl_str_mv Escosteguy,Claudia Caminha
Portela,Margareth Crisóstomo
Vasconcellos,Maurício Teixeira Leite de
Medronho,Roberto de Andrade
dc.subject.por.fl_str_mv Acute myocardial infarction
Healthcare assurance
Quality assurance
Thrombolytic therapy
topic Acute myocardial infarction
Healthcare assurance
Quality assurance
Thrombolytic therapy
description CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS) in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS) with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2). 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4). The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0). Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9) of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6); beta-blockers in 49.0% (95% CI 43.8 to 54.1); angiotensin-converting enzyme (ACE) inhibitors in 63.3% (95% CI 58.2 to 68.1); nitrates in 82.0% (95% CI 82.4 to 89.6); heparin in 81.3% (95% CI 76.9 to 85.0); calcium antagonists in 30.5% (95% CI 26.0 to 35.4). There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and intravenous nitrates). The use of calcium antagonists, not supported by scientific evidence in acute myocardial infarction, was quite frequent. A logistic model documented the benefit of aspirin, beta-blockers and ACE inhibitor use in reducing the chance of hospital death.
publishDate 2001
dc.date.none.fl_str_mv 2001-11-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802001000600003
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802001000600003
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/S1516-31802001000600003
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Associação Paulista de Medicina - APM
publisher.none.fl_str_mv Associação Paulista de Medicina - APM
dc.source.none.fl_str_mv Sao Paulo Medical Journal v.119 n.6 2001
reponame:São Paulo medical journal (Online)
instname:Associação Paulista de Medicina
instacron:APM
instname_str Associação Paulista de Medicina
instacron_str APM
institution APM
reponame_str São Paulo medical journal (Online)
collection São Paulo medical journal (Online)
repository.name.fl_str_mv São Paulo medical journal (Online) - Associação Paulista de Medicina
repository.mail.fl_str_mv revistas@apm.org.br
_version_ 1754209260404736000