[The impact of Chilean health reform in the management and mortality of ST elevation myocardial infarction (STEMI) in Chilean hospitals].
BACKGROUND
In 2005 the Chilean government started a health care reform (AUGE) that guarantees medical treatment for acute myocardial infarction.


OBJECTIVE
To quantify the impact of AUGE on the management and in-hospital mortality of STEMI in a group of Chilean hospitals.


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 procedures in two periods: before (2,623 patients) and after AUGE implementation (906 patients). Logistic regression was used to assess in-hospital 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 there 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 AUGE there was a significant increase in the use of beta 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 in-hospital 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 in-hospital mortality comparing after and before AUGE, was 0.64 (IC 95%, 0.47-0.86).


CONCLUSIONS
The implementation of AUGE has been successful in reducing in-hospital mortality of STEMI This has been achieved through a better use of evidence based medicine and reperfusion strategies.
Nazzal N
Carolina
C
Escuela Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile. cnazzal@med.uchile.cl
Campos T
Pabla
P
Corbalán H
Ramón
R
Lanas Z
Fernando
F
Bartolucci J
Jorge
J
Sanhueza C
Patricio
P
Cavada Ch
Gabriel
G
Prieto D
Juan Carlos
JC
D015906:Angioplasty, Balloon, Coronary; D002677:Chile / Q000453:epidemiology; D003695:Delivery of Health Care / Q000592:standards*; D004632:Emergency Medical Services; D004812:Epidemiologic Methods; D005260:Female; D006284:Health Plan Implementation / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D015425:Myocardial Reperfusion; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome