Resumen de The Brazilian Family Health Program and Secondary Stroke and Myocardial Infarction Prevention: A 6-Year Cohort Study.
Norberto L. Cabral, Selma Franco, Alexandre Longo, Carla Moro, Talita A. Buss, Daniel Collares, Roberta Werlich, Danieli D. Dadan, Cristiane S. Fissmer, Ana Aragão, Priscilla Ferst, Felipe G. Palharini, Jose Eluf-Neto, Luiz A. M. Fonseca, William N. Whiteley, Anderson R. R. Gonçalves
Objectives. We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care. Methods. From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units. Results. In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%. Conclusions. FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction. [ABSTRACT FROM AUTHOR]
