Use of demonstrably effective therapies in the treatment of acute coronary syndromes: comparison between different Brazilian regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE).
BACKGROUND
Little is known in our country about regional differences in the treatment of acute coronary disease.


OBJECTIVE
To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease.


METHODS
A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty).


RESULTS
In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 ± 22.1) was lower (p <0.05) than in the Southeast (77.7 ± 29.5), Midwest (82 ± 22.1) and South (82.4 ± 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 ± 32.9) was lower (p <0.05) than in the Southeast (69.2 ± 31.6), Midwest (65.3 ± 33.6) and South (73.7 ± 28.1) regions; additionally, the score of the Midwest was lower (p <0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p <0.001 compared to the rest of the country).


CONCLUSIONS
The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.
Instituto do Coração (InCOr) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. corjnicolau@incor.usp.br
José Carlos
JC
Nicolau
Marcelo
M
Franken
Paulo Andrade
PA
Lotufo
Antonio Carlos
AC
Carvalho
José Antonio
JA
Marin Neto
Felipe Gallego
FG
Lima
Oscar
O
Dutra
Elias
E
Knobel
Cesar Cardoso
CC
de Oliveira
Sérgio
S
Timerman
Edson
E
Stefanini
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000704:Analysis of Variance; D001938:Brazil; D016000:Cluster Analysis; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards; D018401:Sample Size; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome