Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos

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 thousa...

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Autores principales:	Nazzal N,Carolina, Campos T,Pabla, Corbalán H,Ramón, Lanas Z,Fernando, Bartolucci J,Jorge, Sanhueza C,Patricio, Cavada Ch,Gabriel, Prieto D,Juan Carlos
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2008
Materias:	Myocardial infarction Myocardial reperfusion Thrombolytic therapy
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008001000001
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spelling	oai:scielo:S0034-988720080010000012009-01-15Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenosNazzal N,CarolinaCampos T,PablaCorbalán H,RamónLanas Z,FernandoBartolucci J,JorgeSanhueza C,PatricioCavada Ch,GabrielPrieto D,Juan Carlos Myocardial infarction Myocardial reperfusion Thrombolytic therapy 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 .info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.136 n.10 20082008-10-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008001000001es10.4067/S0034-98872008001000001
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Myocardial infarction Myocardial reperfusion Thrombolytic therapy
spellingShingle	Myocardial infarction Myocardial reperfusion Thrombolytic therapy Nazzal N,Carolina Campos T,Pabla Corbalán H,Ramón Lanas Z,Fernando Bartolucci J,Jorge Sanhueza C,Patricio Cavada Ch,Gabriel Prieto D,Juan Carlos Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos
description	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 .
author	Nazzal N,Carolina Campos T,Pabla Corbalán H,Ramón Lanas Z,Fernando Bartolucci J,Jorge Sanhueza C,Patricio Cavada Ch,Gabriel Prieto D,Juan Carlos
author_facet	Nazzal N,Carolina Campos T,Pabla Corbalán H,Ramón Lanas Z,Fernando Bartolucci J,Jorge Sanhueza C,Patricio Cavada Ch,Gabriel Prieto D,Juan Carlos
author_sort	Nazzal N,Carolina
title	Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos
title_short	Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos
title_full	Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos
title_fullStr	Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos
title_full_unstemmed	Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos
title_sort	impacto del plan auge en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel st, en hospitales chilenos
publisher	Sociedad Médica de Santiago
publishDate	2008
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008001000001
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Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos

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