The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: a 6-year cohort study.
OBJECTIVE
We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care.


METHODS
From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units.


RESULTS
In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%.


CONCLUSIONS
FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.
Department of Medicine, University of Região de Joinville, Univille, Santa Catarina, Brazil. nlcabral@terra.com.br
Norberto L
NL
Cabral
Selma
S
Franco
Alexandre
A
Longo
Carla
C
Moro
Talita A
TA
Buss
Daniel
D
Collares
Roberta
R
Werlich
Danieli D
DD
Dadan
Cristiane S
CS
Fissmer
Ana
A
Aragão
Priscilla
P
Ferst
Felipe G
FG
Palharini
Jose
J
Eluf-Neto
Luiz A M
LA
Fonseca
William N
WN
Whiteley
Anderson R R
AR
Gonçalves
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D009313:National Health Programs / Q000706:statistics & numerical data*; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*