title: Investigation route of the coronary patient in the public health system in Curitiba, São Paulo and in InCor--IMPACT study.
abstract: BACKGROUND
  The investigation of stable coronary artery disease (CAD) and its treatment depend on risk stratification for decision-making on the need for cardiac catheterization and revascularization.
  
  
  OBJECTIVE
  To analyze the procedures used in the diagnosis and invasive treatment of patients with CAD, at the Brazilian Unified Health System (SUS) in the cities of Curitiba, São Paulo and at InCor-FMUSP.
  
  
  METHODS
  Retrospective, descriptive, observational study of the diagnostic and therapeutic itineraries of the Brazilian public health care system patient, between groups submitted or not to prior noninvasive tests to invasive cardiac catheterization. Stress testing, stress echocardiography, perfusion scintigraphy, catheterization and percutaneous or surgical revascularization treatment procedures were quantified and the economic impact of the used strategies.
  
  
  RESULTS
  There are significant differences in the assessment of patients with suspected or known CAD in the metropolitan region in the three scenarios. Although functional testing procedures are most often used the direct costs of these procedures differ significantly (6.1% in Curitiba, 20% in São Paulo and 27% in InCor-FMUSP). Costs related to the procedures and invasive treatments represent 59.7% of the direct costs of SUS in São Paulo and 87.2% in Curitiba. In InCor-FMUSP, only 24.3% of patients with stable CAD submitted to CABG underwent a noninvasive test before the procedure.
  
  
  CONCLUSIONS
  Although noninvasive functional tests are the ones most often requested for the assessment of patients with suspected or known CAD most of the costs are related to invasive procedures/treatments. In most revascularized patients, the documentation of ischemic burden was not performed by SUS.
authors: Incor, FMUSP, São Paulo, SP, Brazil.
authors: Juliano J
authors: JJ
authors: Cerci
authors: Incor, FMUSP, São Paulo, SP, Brazil.
authors: Evelinda
authors: E
authors: Trindade
authors: Incor, FMUSP, São Paulo, SP, Brazil.
authors: Daniel
authors: D
authors: Preto
authors: Quanta Diagnóstico Nuclear, Curitiba, PR, Brazil.
authors: Rodrigo Julio
authors: RJ
authors: Cerci
authors: Incor, FMUSP, São Paulo, SP, Brazil.
authors: Pedro A
authors: PA
authors: Lemos
authors: Quanta Diagnóstico Nuclear, Curitiba, PR, Brazil.
authors: Luiz Antonio Machado
authors: LA
authors: Cesar
authors: Secretaria Municipal de Saúde de São Paulo, São Paulo, SP, Brazil.
authors: Luís
authors: L
authors: Preto
authors: Secretaria Municipal de Curitiba, Curitiba, PR, Brazil.
authors: Luiz
authors: L
authors: Stinghen
authors: Secretaria Estadual da Saúde de São Paulo, São Paulo, SP, Brazil.
authors: Cátia
authors: C
authors: Martinez
authors: Quanta Diagnóstico Nuclear, Curitiba, PR, Brazil.
authors: José Claudio
authors: JC
authors: Meneghetti
mesh_terms: D001938:Brazil; D006328:Cardiac Catheterization / Q000191:economics / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D019091:Critical Pathways; D004452:Echocardiography / Q000191:economics / Q000706:statistics & numerical data; D005080:Exercise Test / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000706:statistics & numerical data; D011877:Radionuclide Imaging / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors