Prevención secundaria post infarto agudo de miocardio en hospitales públicos: implementación y resultados de las garantías GES

• Carolina Nazzal ^[1] ; Fernando Lanas ^[3] ; María Luisa Garmendia ^[1] ; Claudio Bugueño ^[4] ; Enrique Mercadal ^[5] ; Eduardo Garcés ^[6] ; Patricio Yovaniniz ^[7] ; Patricio Sanhueza ^[2]
  1. [1] Universidad de Chile

     Universidad de Chile

     Santiago, Chile

     
  2. [2] Hospital San Juan de Dios

     Hospital San Juan de Dios

     Santiago, Chile

     
  3. [3] Universidad La Frontera
  4. [4] Hospital Regional La Serena
  5. [5] Hospital Regional Talca
  6. [6] Hospital Regional Valdivia
  7. [7] Hospital Barros Luco Trudeau

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• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 141, Nº. 8, 2013, págs. 977-986
• Idioma: español
• Títulos paralelos:
  • Universal health coverage and accomplishment of secondary prevention goals among patients with acute myocardial infarction
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• Resumen

  • Background: In 2005, acute myocardial infarction (AMI) was included in a universal health plan (GES) to reduce inequity in care and optimize its diagnosis and treatment. Aim: To evaluate the effect of GES in risk factor control and therapeutic management among patients with AMI. Material and Methods: A survey was conducted in 2008-2009 in six public hospitals. Patients were identified from a hospital based registry of AMI and evaluated one year later with laboratory tests and an interview. Results: The registry enrolled 534 patients with ST and non ST segment elevation myocardial infarction. Of these, 416 patients aged 63 ± 12 years (25% women) were evaluated one year later. Eighty three percent were evaluated by a cardiologist and 37% by a general practitioner. Twenty two percent were evaluated by a nurse and 22% by a nutritionist. At the moment of the interview, 9% smoked, 78% were overweight or obese, 24% performed moderate or vigorous physical activity ≥ 150 min/week, 60% had systolic pressure > 130 mmHg and 63% a diastolic pressure > 80 mmHg. In 30%, LDL cholesterol was > 100 mg/dl and in 43%, triglycerides were > 150 mm/dl. Twenty two percent were diabetic and among them, 52% had a glycosilated hemoglobin > 7%. Forty five percent of non-diabetic patients had a fasting glucose > 100 mg/dl. Ninety three percent were in treatment with aspirin, 86% with statins, 66% with b-blockers, and 73% with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and 20% with clopidogrel. Conclusions: Despite the high proportion of patients in treatment with evidence-based therapy, many do not achieve the targets for risk factor control with the new health care model.