Disclosure of Potential Conflicts of Interest

Speaker in meetings sponsored by pharmaceutical

companies

Hold stocks from pharmaceutical companies

Writing of educative materials sponsored by

pharmaceutical companies

Receive institutional support from pharmaceutical

companies

Participate in normative committees of scientific trials

sponsored by pharmaceutical companies

Sponsored in clinical trials and/or in basic research

funded by pharmaceutical companies

Sponsoring of transport and/or hotel accommodations

in Congresses

Company (period from 2002 to 2016)

LIBBS, AstraZeneca, MSD,

Servier,

LIBBS, Novartis, MSD, BMS,

Pfizer, Servier

LIBBS, NovaQuimica,

Servier

Categories of potential conflict of interest

Bayer

–

–

Bayer

ACS Management in Low-Resource Settings

David De Padua Brasil, MD, MSc, FIACS, FICA

FELUMA/CMMG Faculdade de Ciencias Medicas de Minas Gerais,

School of Medicine

Director, Jose Haddad Cardiovascular Investigation Center (CIC),

University Hospital Ciencias Medicas

Belo Horizonte - MG, Brazil

Marcolino MS, Brant LC, Araujo JG, Nascimento BR, Castro LR, Martins P, et al.

Arq Bras Cardiol 2013;100(4):307-14. PubMed PMID: 23545995.

Characteristics of ACS Healthcare Assistance in the Metropolitan Area of

Belo Horizonte, MG - Brazil - Retrospective Observational Study

Quality Criteria Assessment

Nascimento BR, et al. Arq Bras Cardiol, 2016

71st Brazilian Congress of Cardiology 2016

“Quality of Healthcare Evaluation in Patients with

Myocardial Infarction Admitted in the Coronary

Care Unit of Hospital of Clinics, UFMG”

Measures of quality were performed according to

the ACC/AHA 2008 Performance Measures for

Adults With ST-Elevation and Non–ST-Elevation

Myocardial Infarction

Admission Chart for Social-Insured AMI Patients

SUS - Unified Healthcare System - Belo Horizonte, MG - Brazil

6 UPAs• Barreiro

• Nordeste

• Norte

• Oeste

• Pampulha

• Venda Nova

Demographic Characteristics STEMI NSTEMIN=788 (69.8) N=341 (30.2)

Age (years) 59 (51-67) 62 (54-72)

Gender - absolute number (%)

Male 544 (69) 221 (64.8)

Female 244 (31) 120 (35.2)

Ethnicity - absolute number (%)

Caucasian 300 (38.1) 144 (42.2)

Asiatic 6 (0.8) 4 (1.2)

Black 109 (13.8) 40 (11.7)

Mixed 285 (36.2) 125 (36.7)

Not reported 88 (11.2) 28 (8.2)

Origin

ER - Hospital of Clinics 21 (2.7) 30 (8.8)

Units of Urgency/Emergency Care UPAs 193 (24.5) 74 (21.7)

Various hospitals in Belo Horizonte 169 (21,4) 109 (32)

ERs - Metropolitan Area of Belo Horizonte 319 (40.5) 88 (25.8)

ERs - Other cities an towns 74 (9.4) 30 (8.8)

Not identified 12 (1.5) 10 (2.9)

Demographic Characteristics of Patients with STEMI and NSTEMI

Quality of Healthcare in Patients Admitted in the

CCU of Hospital of Clinics - UFMG - Belo Horizonte

Nascimento BR, et al. Arq Bras Cardiol, 2016

71st Brazilian Congress of Cardiology 2016

Clinical Characteristics STEMI NSTEMI

N=788 (69.8) N=341 (30.2)

Clinical Features - absolute number (%)

Killip I 490 (62.2) 239 (70.1)

Killip II 175 (22.2) 67 (19.6)

Killip III 39 (4.9) 25 (7.3)

Killip IV 84 (10.7) 10 (2.9)

Previous history

Hypertension 523 (66.4) 273 (80.1)

Diabetes Mellitus 190 (24.1) 107 (31.4)

Dyslipidemia 347 (44) 194 (56.9)

Smoking 344 (43.7) 94 (27.6)

Family history of early CAD 186 (23.6) 86 (25.2)

AMI 59 (7.5) 86 (25.2)

PTCA 11 (1.4) 26 (7.6)

CABG 8 (1) 10 (2.9)

Cerebrovascular Disease 42 (5.3) 15 (4.4)

Clinical Characteristics of Patients with STEMI and NSTEMI

Quality of Healthcare in Patients Admitted in the

CCU of Hospital of Clinics - UFMG - Belo Horizonte

Nascimento BR, et al. Arq Bras Cardiol, 2016

71st Brazilian Congress of Cardiology 2016

Adherence to AHA/ACC Quality Criteria in Patients with STEMI and NSTEMI

Quality of Healthcare in Patients Admitted in the

CCU of Hospital of Clinics - UFMG - Belo Horizonte

Quality Criteria STEMI NSTEMIN= 788 (69.8) N= 341 (30.2)

Door to Needle Time < 30 minutesYes 36 (13.6)No 228 (86.4)Not Applicable 524 341

Door to Balloon Time < 90 minutesYes 128 (75.3)No 42 (24.7)Not Applicable 618 341

Reperfusion Therapy (chemical thrombolysis)Yes 400 (56.0)No 314 (43.1)Not Applicable 74 341

Time since arrival at the ER + Time until arrival at referring hospital for primary PTCA < 60 minutesYes 10 (5.2)No 181 (94.8)Not Applicable 597 341

Time since arrival at the ER + Time until balloon inflation < 120 minutesYes 7 (4.2)No 159 (95.8)Not Applicable 622 341

Nascimento BR, et al. Arq Bras Cardiol, 2016. 71st Brazilian Congress of Cardiology 2016

Time Intervals in the Referral (transfer) of STEMI Patients

Quality of Healthcare in Patients Admitted in the

CCU of Hospital of Clinics - UFMG - Belo Horizonte

TIME (minutes) Minimum1st

QuartileMedian

3rd

QuartileMaximum

From Admission to Thrombolytic Therapy

in the UPAs 0 60 100 176.25 2424

From Admission in the UPAs

Until Arrival at HC 50 180 270 390 1020

From Admission in the UPAs

Until Balloon Inflation at HC 80 234 352 501 1072

From Arrival at HC

Until Balloon Inflation at the Cath Lab 10 40 66 90 715

HC: Hospital of Clinics (tertiary university hospital; UFMG: Federal University of Minas Gerais

Nascimento BR, et al. Arq Bras Cardiol, 2016

71st Brazilian Congress of Cardiology 2016

Quality of Healthcare in Patients Admitted in the

CCU of Hospital of Clinics - UFMG - Belo HorizonteIndependent Variables Associated with Adherence to the

AHA/ACC Quality Measures for AMI (>80% of criteria were applicable)

Multivariate Regression Model

Variable OR 95% CI p-value

Gender (male) 1.33 1.01-1.76 0.046*

Killip Class I or II (at admission) 1.95 1.36-2.80 <0.001*

Diagnosis of NSTEMI 5 3.51-7.12 <0.001*

Date of admission with AMI

in the referral system (Belo Horizonte/Semester) 1.19 1.10-1.28 <0.001*

OR: Odds-ratio; CI: 95% confidence interval ; *p < 0.005

Nascimento BR, et al. Arq Bras Cardiol, 2016

71st Brazilian Congress of Cardiology 2016

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