Increased mortality and morbidity due to acute myocardial infarction in a public hospital, in Feira de Santana, Bahia.
BACKGROUND
Factors related to socioeconomic status and health care quality and management may influence mortality and morbidity rates due to acute myocardial infarction (AMI).


OBJECTIVE
To compare mortality and morbidity in patients with AMI hospitalized in public and private hospitals.


METHODS
An observational study, with comparison groups. Clinical evaluation on admission, and recording of diagnostic, therapeutic and evolution data until discharge or death. Comparison of clinical characteristics by univariate analysis followed by bivariate analysis, evaluating the combination of predictors with death and morbidity (Killip> I), SPSS, version 13.0.


RESULTS
150 patients were evaluated, 63 (42.0%) of private hospitals and 87 (58.0%) of public hospitals, with 63.1% and 62.1% of males, aged 61.1 +/- 13.8 and 60.0 +/- 11.6 years, respectively. The mortality from AMI was 19.5% in public hospitals vs 4.8% in private hospitals (p = 0.001), and morbidity (Killip class> I) was 34.3% in public hospitals vs 15.0% in private hospitals (p = 0.012). There was a significant difference between public and private patients, due to lower family income and education (70.1% with one to two salaries vs 19.0%, p <0.001, and 49.4% of illiterates vs 6.3%, p <0.001, respectively ); late arrival at the hospital (HAT> 1 hour: 76.9% vs 48.6%, p = 0.003); and a longer period of time before being medicated (AMT > 15 minutes: 47.1% vs 8.0%; p <0.001); ICU for 8% of the patients in public hospitals vs 94% in private hospitals; and thrombolysis for 20.6% vs 54.0%, respectively (p <0.001).


CONCLUSIONS
Mortality and morbidity were greater among public patients, which presented more serious conditions, arrived later at the hospital and received lower quality treatment.
Ferreira
Graça Maria Tavares de Melo
GM
Escola Bahiana de Medicina e Saúde Pública (EBMSP) - Fundação Bahiana para o Desenvolvimento das Ciências (FBDC), Salvador, BA, Brazil.
Correia
Luis Cláudio
LC
Reis
Helena
H
Ferreira Filho
Carlos Brandão
CB
Freitas
Francisco
F
Ferreira
Guilherme Melo
GM
Júnior
Ivan
I
Oliveira
Nelson
N
Guimarães
Armênio Costa
AC
D000208:Acute Disease; D001938:Brazil / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000401:mortality*; D013997:Time Factors