PMID- 19194618
OWN - NLM
STAT- MEDLINE
DCOM- 20091006
LR  - 20181201
IS  - 0034-9887 (Print)
IS  - 0034-9887 (Linking)
VI  - 136
IP  - 10
DP  - 2008 Oct
TI  - [The impact of Chilean health reform in the management and mortality of ST 
      elevation myocardial infarction (STEMI) in Chilean hospitals].
PG  - 1231-9
AB  - BACKGROUND: In 2005 the Chilean government started a health care reform (AUGE) 
      that guarantees medical treatment for acute myocardial infarction. AIM: To 
      quantify the impact of AUGE on the management and in-hospital mortality of STEMI 
      in a group of Chilean hospitals. MATERIAL AND METHODS: Three thousand five 
      hundred and forty six patients with STEMI from 10 hospitals that perform 
      thrombolysis as the main reperfusion therapy were analyzed. We compared 
      demographic and clinical characteristics, hospital treatments and 
      revascularization procedures in two periods: before (2,623 patients) and after 
      AUGE implementation (906 patients). Logistic regression was used to assess 
      in-hospital mortality according to AUGE in the entire sample and stratified by 
      risk groups. RESULTS: We found no differences in demographic and clinical 
      characteristics between the two groups. During AUGE there was a significant 
      increase in the use of thrombolysis (50% to 60.5%), which was associated to an 
      increase of hypotension from 29% to 35% (p<0.02) and minor bleedings, from 1.6% 
      to 3.4% (p<0.001). After AUGE there was a significant increase in the use of beta 
      blockers (65% to 75%), angiotensin converting enzyme inhibitors (70% to 76%), 
      statins (48% to 58%), and aspirin (96% to 97.5%) (p<0.05). Global in-hospital 
      mortality decreased from 12.0% to 8.6% (p<0.003) and from 10.6% to 6.8% (p<0.005) 
      in patients treated with thrombolytics. The adjusted odds ratio for in-hospital 
      mortality comparing after and before AUGE, was 0.64 (IC 95%, 0.47-0.86). 
      CONCLUSIONS: The implementation of AUGE has been successful in reducing 
      in-hospital mortality of STEMI This has been achieved through a better use of 
      evidence based medicine and reperfusion strategies.
FAU - Nazzal N, Carolina
AU  - Nazzal N C
AD  - Escuela Salud Publica, Facultad de Medicina, Universidad de Chile, Santiago, 
      Chile. cnazzal@med.uchile.cl
FAU - Campos T, Pabla
AU  - Campos T P
FAU - Corbalan H, Ramon
AU  - Corbalan H R
FAU - Lanas Z, Fernando
AU  - Lanas Z F
FAU - Bartolucci J, Jorge
AU  - Bartolucci J J
FAU - Sanhueza C, Patricio
AU  - Sanhueza C P
FAU - Cavada Ch, Gabriel
AU  - Cavada Ch G
FAU - Prieto D, Juan Carlos
AU  - Prieto D JC
CN  - Grupo GEMI
CN  - Departamento de Estudios Multicentricos, Sociedad Chilena de Cardiologia y 
      Cirugia Cardiovascular
LA  - spa
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
TT  - Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al 
      miocardio con supradesnivel ST, en hospitales chilenos.
DEP - 20090115
PL  - Chile
TA  - Rev Med Chil
JT  - Revista medica de Chile
JID - 0404312
SB  - IM
MH  - Angioplasty, Balloon, Coronary
MH  - Chile/epidemiology
MH  - Delivery of Health Care/*standards
MH  - Emergency Medical Services
MH  - Epidemiologic Methods
MH  - Female
MH  - Health Plan Implementation/*standards
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*mortality/therapy
MH  - Myocardial Reperfusion
MH  - Thrombolytic Therapy/statistics & numerical data
MH  - Treatment Outcome
FIR - Gatica, Mario
IR  - Gatica M
FIR - Gaete, Pablo
IR  - Gaete P
FIR - Bustos, Carlos
IR  - Bustos C
FIR - Araya, Maria Virginia
IR  - Araya MV
FIR - Bonacic, Fernando
IR  - Bonacic F
FIR - Saldias, Carlos
IR  - Saldias C
FIR - Gonzalez, Hans
IR  - Gonzalez H
FIR - Huerta, Angelica
IR  - Huerta A
FIR - Bugueno, Claudio
IR  - Bugueno C
FIR - Cortes, Patricia
IR  - Cortes P
FIR - Mondaca, Patricia
IR  - Mondaca P
FIR - Gonzalez, Ana Maria
IR  - Gonzalez AM
FIR - Tijerino, Marco Antonio
IR  - Tijerino MA
FIR - Lanas, Fernando
IR  - Lanas F
FIR - Standen, Dina
IR  - Standen D
FIR - Garces, Eduardo
IR  - Garces E
FIR - Riquelme, Herminia
IR  - Riquelme H
FIR - Venegas, Jaime
IR  - Venegas J
FIR - Hidalgo, Soledad
IR  - Hidalgo S
FIR - Correa, Alejandra
IR  - Correa A
FIR - Campos, Pabla
IR  - Campos P
FIR - Conejeros, Carlos
IR  - Conejeros C
FIR - Lamich, Ruben
IR  - Lamich R
FIR - Gallardo, Ligia
IR  - Gallardo L
FIR - Yovaniniz, Patricio
IR  - Yovaniniz P
FIR - Alfaro, Paola
IR  - Alfaro P
FIR - Campos, Pabla
IR  - Campos P
FIR - Nazzal, Carolina
IR  - Nazzal C
FIR - Bartolucci, Jorge
IR  - Bartolucci J
FIR - Corbalan, Ramon
IR  - Corbalan R
FIR - Lanas, Fernando
IR  - Lanas F
FIR - Prieto, Juan Carlos
IR  - Prieto JC
FIR - Sanhueza, Patricio
IR  - Sanhueza P
EDAT- 2009/02/06 09:00
MHDA- 2009/10/07 06:00
CRDT- 2009/02/06 09:00
PHST- 2009/02/06 09:00 [entrez]
PHST- 2009/02/06 09:00 [pubmed]
PHST- 2009/10/07 06:00 [medline]
AID - S0034-98872008001000001 [pii]
PST - ppublish
SO  - Rev Med Chil. 2008 Oct;136(10):1231-9. Epub 2009 Jan 15.