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Revista médica de Chile

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NAZZAL N, Carolina et al. The impact of Chilean health reform in the management and mortality of ST elevation myocardial infarction (STEMI) in Chilean hospitals. Rev. méd. Chile [online]. 2008, vol.136, n.10, pp.1231-1239. ISSN 0034-9887.

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 and methods: 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% to 60.5%), which was associated to an increase of hypotension from 29% to 35% (p <0.02) and minor bleedings, from 1.6% to 3.4% (p <0.001). After A UGE there was a significant increase in the use ofbeta blockers (65% to 75%), angiotensin converting enzyme inhibitors (70% to 76%), statins (48% to 58%), and aspirin (96% to 97.5%) (p <0.05). Global inhospital mortality decreased from 12.0% to 8.6% (p <0.003) and from 10.6% to 6.8% (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%, 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 .

Keywords : Myocardial infarction; Myocardial reperfusion; Thrombolytic therapy.

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