Impacto da implementação do serviço de atendimento móvel de urgência na mortalidade por Infarto Agudo do Miocárdio no estado de Minas Gerais.

Abstract

Introduction: Acute Myocardial Infarction (AMI) is the leading cause of death in Brazil. The adequate treatment offered in a timely manner is able to decrease its morbidity and mortality. Prehospital care is fundamental for the rapid attendance to the condition, being performed in our environment by the Emergency Medical Service, a Nationwide system called SAMU. The aim of this study is to analyze the impact of SAMU implementation in the state of Minas Gerais (MG) in the period 2008-2016 on mortality, lethality and hospitalizations for AMI. Methods: We evaluated all municipalities of MG in the period 2008-2016 through a retrospective and observational study. Using data from patients treated in the Unified Health System (SUS), the Hospital Hospitalization System (SIH) and the Mortality Information System (SIM), we analyzed the relationship between SAMU care in each municipality and mortality due to AMI in the general population, in-hospital mortality and number of hospitalizations. The analyzed rates were corrected by age structure, according to Minas Gerais population in 2010. We used the Poisson hierarchical model to analyze the association between SAMU with the outcomes studied and the Empirical Bayes method for correcting rates. Results: Mortality rates for the set of MG municipalities showed a decreasing tendency in the studied period, on average 2% per year, and seasonal variation, being higher during winter months. There was an association between SAMU implementation and a decrease in mortality - OR 0.967 (0.936 - 0.998 CI 95%) and lethality - OR 0.914 (0.845 - 0.986 CI 95%), but no impact on hospitalizations - OR 1.003 (0.927 - 1.083 CI 95%). Conclusion: SAMU implementation was related to a modest but significant decrease in AMI mortality and in-hospital mortality. This finding reinforces pre hospital care's main role to attend AMI and reinforces the need to expand the still incipient organization of Systems of Care in the state of MG.