Efectividad de un programa de prevención secundaria cardiovascular en Uruguay

Rosana Gambogi; Marcela Baldizzoni; Gustavo Fernando Saona; Álvaro Niggemeyer; María Isabel Wald; Sonia Estela Nigro; Elba Inés Esteves; Abayubá Perna; Henry Albornoz

Rosana Gambogi Fondo Nacional de Recursos, Dirección Técnica, Co-encargada. Especialista en Gestión de Servicios de Salud
Marcela Baldizzoni Fondo Nacional de Recursos. Lic. en Enfermería. Especialista en Gestión de Servicios de Salud. Especialista en Gestión de Calidad UNIT. Especialista en Cuidados Intensivos e Intermedios. Especialista en Control de Infecciones Intrahospitalarias
Gustavo Fernando Saona Fondo Nacional de Recursos. Asesor bioestadístico
Álvaro Niggemeyer Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Emergencia. Prof. Adj
María Isabel Wald Fondo Nacional de Recursos. Lic. en Enfermería. Especialista en Cuidados Intensivos e Intermedios. Especialista en Control de Infecciones Intrahospitalarias. Especialista en Cuidados Neurocríticos
Sonia Estela Nigro Fondo Nacional de Recursos. Lic. en Nutrición. Universidad de la República, Nutrición Clínica. Profesora Titular
Elba Inés Esteves Fondo Nacional de Recursos. Mag. en Tabaquismo. Universidad de la República, Facultad de Medicina. Ex Asistente
Abayubá Perna Fondo Nacional de Recursos, Asesor bioestadístico. Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto de Neurología. Profesor Adjunto
Henry Albornoz Fondo Nacional de Recursos. Médico especialista en Medicina Intensivista. Especialista en Enfermedades Infecciosas

Keywords: CARDIOVASCULAR DISEASES, RISK FACTORS, SECONDARY PREVENTION, MYOCARDIAL REVASCULARIZATION, COHORT STUDIES

Abstract

Background: secondary prevention programs for patients with heart disease reduce mortality, the risk of recurrence of coronary events and improve the quality of life. The Fondo Nacional de Recursos (National Resources Fund) implemented a program for patients who underwent coronary revascularization.
Objective: to compare survival and the incidence of a new revascularization in patients included in this program with a cohort control.
Method: the intervention cohort was made up by the patients who underwent revascularization from December, 2003, through June 2007 and were around 70 years old. The cohort control was made up by the patients who underwent revascularization from January, 2003 through May, 2007 and received conventional treatment. Two controls were matched to each case by means of a propensity score matching, stratification being based on healthcare and revascularization procedure subsectors. Death, new revascularization or a combination of both events in a four years term were studied. Survival was analysed through the Kaplan-Meier, stratified Cox regression and competitive risk analysis methods.
Results: 1.348 patients were admitted and they were matched with 2.696 controls. Both cohorts evidenced a good matching. Survival free of the combined event (death or new revascularization) within a four years term was 81.2% and 79.3% in the program and control groups respectively (HR = 0.83, p = 0.028). Survival in patients of the public sector was 93.2% and 88.5% in the program and control groups respectively (HR = 0.62, p = 0.023).
Conclusion: the program was effective in terms of reducing the occurrence of combined events in the entire population, as well as in reducing global mortality in the short and mid-term in the group made up by patients of the public sub-sector.

References

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Effectiveness of a cardiovascular secondary prevention program in Uruguay

Abstract

References

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