Characterization of the variation of health care taking into account the costs of hospital admissions for acute myocardial infarction in Brazilian Unified Health System

ABSTRACT:

Introduction:

The global epidemiologic scenario indicates an increase in cardiovascular disease rates, with special emphasis on acute myocardial infarction (AMI), owing to its large magnitude and severity. In Brazil, coronary diseases now account for about 5% of hospital admission expenditures.

Objective:

To characterize the admissions in the Brazilian Unified Health System of patients with AMI, by identifying clusters suggested by a traditional cluster analysis and by a multiple correspondence analysis (MCA).

Methods:

The records of the Hospital Information System/Brazilian Unified Health System with a primary diagnosis of AMI in the State of Rio de Janeiro, Brazil, 2002, were selected and subsequently related to the records of the Mortality Information System. Next, an MCA and a metric called the tolerance distance were used for cluster identification. The variable of interest was "hospital expenditures", classified into two categories (above and below BRL 905).

Results:

"Higher costs" were associated with "use of the Intensive Care Unit (ICU)" and "moderate severity of the case" and "lower costs" with "low severity" and "nonuse of the ICU". On the other hand, high severity cases, with no apparent association with "use of ICU" or other categories. Other associations identified were "lower costs" and "no displacement of the patient," "female," "age between 56 and 75 years," "death within 30 days," and "death within 1 year".

Conclusions:

The nonclustered characteristic of the most serious cases and the association between "deaths" and "lower costs" suggests that the technological resources available during hospitalization for AMI are not being properly used.

Keywords:
Health services accessibility; Myocardial infarction; Delivery of health care; Hospital mortality; Risk factors; Multifactor dimensionality reduction