Healthcare Disparities

IJCS

Letter to the Editor

Beyond the Numbers: A Critical Analysis of DATASUS on Cardiovascular Mortality

João Pedro Azevedo Lopes et al. João Emmanuel Coelho de Morais Pedro Pereira Tenório

Dear Editor,

We are writing to express our appreciation for the article “Epidemiological Analysis of Emergency Hospitalizations in Brazil Due to Cardiovascular Diseases From 2013 to 2023” by Luiz et al. This work is of great relevance, as it provides a robust and updated epidemiological overview (2013–2023) of Cardiovascular Diseases (CVD) in Brazil, which remain one of the country’s major public health challenges. The use of a decade of DATASUS data gives the study indispensable temporal breadth for long-term trend analysis, representing one of its greatest strengths.

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IJCS

Editorial

Challenges and Perspectives for Cardiology in the Developing World: Joint Views from Africa and Latin America

Mauer A. A. Gonçalves et al. Humberto Morais Gláucia Maria Moraes de Oliveira Cláudio Tinoco Mesquita

How to face challenges and promote improvements?

In 2017, a survey revealed that 18% of the 33 participating African countries had no registered cardiologists.^, Across Africa, there are approximately 2000 registered cardiologists for a population of 1.2 billion inhabitants. There is a scarcity of cardiac surgery and interventional cardiology services, with around 22 cardiothoracic centers in Africa, and 30% of African countries lack artificial cardiac stimulation therapies and cardiac electrophysiology.^– The lack of qualified human resources is a critical obstacle. The region faces a shortage of health professionals equipped to handle CVD. The specialized training process is lengthy and inadequate, contributing to this gap.^, Compared to Africa, Latin America has a great number of estimated cardiologists: 25000 to 30000. According to the 2023 Brazilian Medical Demographics study, the cardiology field has 20324 licensed professionals. Angola, an African low- to middle-income country with an estimated population of 34.0 million inhabitants, has made notable efforts in training specialists in cardiology and cardiac surgery. There are currently around 100 registered cardiologists, including 4 interventional cardiologists and 5 cardiologists who autonomously implant cardiac stimulation devices. There are also 10 cardiac surgeons, all of whom were trained abroad.

Reducing the burden of CVD in Latin America and Africa requires a multi-faceted approach that addresses various factors. For instance, collaboration with middle- and high-income countries plays a crucial role in establishing specialized centers and training professionals. However, the sustainability of these centers is challenged by economic fluctuations and political instabilities, affecting the continuity of these services.^, Inclusive health policies are crucial to ensure equitable access to medical services and medications for CVD. Expanding health insurance coverage and providing accessible therapies are fundamental steps in this direction. Partnerships between countries, both North-South and South-South, are essential to strengthen specialized workforces and improve cardiovascular care.^,,

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ABC

Original Article

Access to Reperfusion Therapy and Mortality in Women with ST-Segment–Elevation Myocardial Infarction: VICTIM Register

Jussiely Cunha Oliveira et al. Mayse Pereira Souza Barros Ikaro Daniel de Carvalho Barreto Rubens Cruz Silva Filho … Volfanio Araújo Andrade André de Melo Oliveira Ticiane Clair Remacre Munareto Lima Jeferson Cunha Oliveira Larissa Andreline Maia Arcelino Laís Costa Souza Oliveira Eduesley Santana-Santos Marcos Antônio Almeida-Santos Antônio Carlos Sousa José Augusto Soares Barreto Filho

Abstract

Background:

Myocardial reperfusion is a fundamental part of the treatment for ST elevation myocardial infarction (STEMI) and is responsible for reducing morbidity and mortality in affected patients. However, reperfusion rates are usually lower and mortality rates higher in women compared to men.

Objectives:

To evaluate the prevalence of the use of reperfusion therapies among women and men with STEMI in hospitals where percutaneous coronary intervention (PCI) is available in the state of Sergipe.

Methods:

This is a cross-sectional study that used data from the VICTIM Register. Patients diagnosed with STEMI admitted to the four hospitals (one public and three private) where PCI is available in the state of Sergipe were evaluated, from December 2014 to June 2018. A multivariate analysis with adjusted model using mortality as a dependent variable was made. In all analyses, the level of significance adopted was 5% (p < 0.05).

Results:

A total of 878 volunteers with a confirmed diagnosis of STEMI, of which 33.4% were women, were included in the study. Only 53.3% of the patients underwent myocardial reperfusion (134 women versus 334 men). Fibrinolysis was performed only in 2.3% of all patients (1.7% of women versus 2.6% of men; p = 0.422). The rate of primary PCI was lower (44% versus 54.5%; p = 0.003) and hospital mortality was higher (16.1% versus 6.7%; p < 0.001) in women than in men.

Conclusion:

Women have significantly lower rates of primary PCI and higher hospital mortality. Reperfusion rates were low in both sexes and there was a clear underutilization of thrombolytic agents.

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Original Article

Quality of Intra-Hospital Nutritional Counseling in Patients with STEMI in the Public and Private Health Networks of Sergipe: The VICTIM Register

Ticiane Clair Remacre Munareto Lima et al. Danielle Góes da Silva Ikaro Daniel de Carvalho Barreto Jussiely Cunha Oliveira … Laís Costa Souza Oliveira Larissa Andreline Maia Arcelino Jeferson Cunha Oliveira Antônio Carlos Sobral Sousa José Augusto Soares Barreto Filho

Abstract

Background:

Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored.

Objective:

To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe.

Methods:

A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted.

Results:

A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001).

Conclusion:

The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

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IJCS

Original Article

Disparities in Acute Myocardial Infarction Treatment Between Users of the Public and Private Healthcare System in Sergipe

Jussiely Cunha Oliveira et al. Laís Costa Souza Oliveira Jeferson Cunha Oliveira Ikaro Daniel de Carvalho Barreto … Marcos Antonio Almeida-Santos Ticiane Clair Remacre Munareto Lima Larissa Andreline Maia Arcelino Luiz Flávio Andrade Prado Fábio Serra Silveira Thiago Augusto Nascimento Eduardo José Pereira Ferreira Rafael Vasconcelos Barreto Enilson Vieira Moraes José Teles de Mendonça Antonio Carlos Sobral Sousa José Augusto Barreto-Filho

Abstract

Background:

The Brazilian Unified Health System (SUS) was created to ensure universal, integral and equitable access to quality healthcare to Brazilians. However, studies scrutinizing the quality of the healthcare provided by the SUS are scarce. This is especially critical for patients with ST-elevation myocardial infarction (STEMI), who depend on healthcare system responsiveness and timely reperfusion to achieve better outcomes.

Objective:

To describe the methodology of the VICTIM Registry aimed at characterizing and comparing the access to effective therapies and the outcomes of patients with STEMI, who use the SUS and the private healthcare system at hospitals capable of performing angioplasty in Sergipe. In addition, that registry aimed at identifying and measuring possible disparities in the quality of the care provided.

Methods and Results:

The VICTIM Registry is an observational study, launched in December 2014, being still in the data collection phase, to investigate: the epidemiology of STEMI in Sergipe, the temporal and geographic courses of the patients up to their admission to one of the hospitals capable of performing angioplasty, the reperfusion therapy rates, the quality of the healthcare provided during the event, and the 30-day mortality. It compares the results obtained in the SUS with those of the private healthcare system.

Conclusions:

The VICTIM Registry is an interinstitutional effort to identify opportunities for healthcare improvement for SUS and private healthcare system patients with STEMI. It is expected to provide healthcare managers with information to support new, more efficient and equitable healthcare policies.

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