Acesso à internação e fatores associados ao óbito hospitalar por doenças isquêmicas do coração no SUS

Evangelista, Patrícia Alves; Barreto, Sandhi Maria; Guerra, Henrique Leonardo

doi:10.1590/s0066-782x2008000200009

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…1 Other studies have found associations between age and hospital death. 5,7,17,22 It was observed that males presented a greater chance of death than did females; an association between sex and hospital mortality has already been described in the literature. 1,5,18 On the other hand, in an analysis on myocardial revascularization surgery, Noronha et al 5 (2003) found a greater likelihood of death among women.…”

Section: Discussionmentioning

confidence: 77%

“…This model can be used to predict hospital deaths and is in accordance with other proposals in the literature that also used logistic regression models to predict hospital deaths according to patients' profi les. 1,7,17 The fi nal model presented good predictive performance, with an area under the ROC curve of 0.781, and it is proposed that this should be a general index. Other studies have been conducted in relation to specifi c diagnoses, using variables from the HIS-SUS database to predict hospital deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have also found associations between hospital mortality and use of ICUs. 5,7 Note: Position 1 indicates the best performance and position 25 indicates the worst performance.…”

Section: Discussionmentioning

confidence: 99%

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Modelo preditivo de óbito a partir de dados do Sistema de Informações Hospitalares

et al. 2010

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Modelo preditivo de óbito a partir de dados do Sistema de Informações Hospitalares

et al. 2010

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“…Para cada dia a mais de internação no hospital e na UTI, o modelo final estimou incrementos na chance de morte hospitalar de 1,0 e de 4,0%, respectivamente. Diversos autores, entre eles Noronha e colaboradores, 6 Evangelista e colaboradores, 13 Gomes e colaboradores 4 e Dias e colaboradores, 14 também encontraram associação positiva entre TMH e uso de UTI. Trata-se de resultados esperados, uma vez que pacientes mais graves necessitam de tecnologias mais complexas, demandando maior tempo de internação hospitalar e uso mais prolongado de UTI, além do que, por sua condição de base (anterior), possuem maior probabilidade de morte durante o período de internação.…”

Section: Discussionunclassified

“…Essas observações discordam daquelas obtidas por Gomes e colaboradores, 4 que encontraram taxa de mortalidade superior nos hospitais da rede pública (7,19%) quando comparada à TMH em comparação com os hospitais privados (6,04%), em atendimentos SUS no Rio Grande do Sul (OR ajustado=1,6). Da mesma forma, Evangelista e colaboradores, 13 ao es- 4 sobre o Rio Grande do Sul. No DF, observou-se maior chance de óbitos nos hospitais de médio porte (8,0%), seguidos dos de grande porte (3,8%) e de pequeno porte (0,0%).…”

Section: Discussionunclassified

Fatores associados à chance para a mortalidade hospitalar no Distrito Federal

Junqueira¹,

Duarte²

2013

Epidemiol. Serv. Saúde

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Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis

Sorita

Ahmed

Starr

et al. 2014

BMJ

184

175

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Objective To assess the association between off-hour (weekends and nights) presentation, door to balloon times, and mortality in patients with acute myocardial infarction.Data sources Medline in-process and other non-indexed citations, Medline, Embase, Cochrane Database of Systematic Reviews, and Scopus through April 2013.Study selection Any study that evaluated the association between time of presentation to a healthcare facility and mortality or door to balloon times among patients with acute myocardial infarction was included.Data extraction Studies' characteristics and outcomes data were extracted. Quality of studies was assessed with the Newcastle-Ottawa scale. A random effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I .Results 48 studies with fair quality, enrolling 1 896 859 patients, were included in the meta-analysis. 36 studies reported mortality outcomes for 1 892 424 patients with acute myocardial infarction, and 30 studies reported door to balloon times for 70 534 patients with ST elevation myocardial infarction (STEMI). Off-hour presentation for patients with acute myocardial infarction was associated with higher short term mortality (odds ratio 1.06, 95% confidence interval 1.04 to 1.09). Patients with STEMI presenting during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes (odds ratio 0.40, 0.35 to 0.45) and had longer door to balloon time by 14.8 (95% confidence interval 10.7 to 19.0) minutes. A diagnosis of STEMI and countries outside North America were associated with larger increase in mortality during off-hours. Differences in mortality between off-hours and regular hours have increased in recent years. Analyses were associated with statistical heterogeneity. ConclusionThis systematic review suggests that patients with acute myocardial infarction presenting during off-hours have higher mortality, and patients with STEMI have longer door to balloon times. Clinical performance measures may need to account for differences arising from time of presentation to a healthcare facility. IntroductionAcute myocardial infarction remains a leading cause of death worldwide.1 Every year, approximately one million people in the United States have an acute myocardial infarction and 400 000 die from coronary heart disease.2 Previous studies have suggested that patients with acute myocardial infarction who present to the hospital during off-hours (weekends and nights) may have higher mortality. [3][4][5][6] Higher mortality during off-hours may be attributed to a lower likelihood of receiving evidence based treatment or timely reperfusion therapies.6 7 Furthermore, the number of hospital staff and their level of expertise may contribute to gaps in the quality of care during off-hours. 4 8 9Because of the high incidence and case fatality of acute myocardial infarction, small increases in the relative risk of mortality during off-hours can translate to important effects in the population.Using data from the National Re...

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Acesso à internação e fatores associados ao óbito hospitalar por doenças isquêmicas do coração no SUS

Abstract: SummaryBackground: Analyses on mortality rate due to diseases when outcome depends on proper, timely medical intervention may point out the vulnerabilities and inequity associated to health care access. Ischemic heart diseases will act as models for such assessment.

Cited by 9 publications

References 28 publications

Modelo preditivo de óbito a partir de dados do Sistema de Informações Hospitalares

Modelo preditivo de óbito a partir de dados do Sistema de Informações Hospitalares

Fatores associados à chance para a mortalidade hospitalar no Distrito Federal

Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis

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