Implementation of the Myocardial Infarction System of Care in City of Belo Horizonte, Brazil

Background: The creation of an acute myocardial infarction (AMI) system of care aims to optimize the management of patients from early diagnosis to proper and timely treatment. Objective: To assess the establishment of an AMI System of Care in the City of Belo Horizonte, state of Minas Gerais, and its impact on AMI in-hospital mortality. Methods The AMI system of care was established in the City of Belo Horizonte between 2010 and 2011, aiming at increasing the access of patients of the public health system to the treatment recommended by the existing guidelines. The teams at the emergency care units were trained, and the tele-electrocardiography system was implemented in those units. The primary outcomes of this retrospective observational study were the number of admissions and AMI in-hospital mortality, from 2009 to 2011. Results: During the study period, 294 professionals were trained and 563 electrocardiograms (ECGs) transmitted from emergency care units to coronary care units. A significant reduction was observed in the in-hospital mortality rate (12.3% in 2009 versus 7.1% in 2011, p < 0.001), while the number of admissions due to AMI remained stable. The mean cost of admission increased (mean R$ 2,480.00 versus R$ 3,501.00; p < 0.001), the proportion of admissions including intensive care unit stay increased (32.4% in 2009 versus 66.1% in 2011; p < 0.001), and the number of patients admitted to tertiary hospitals increased (47.0% versus 69.6%; p < 0.001). Conclusion: The establishment of the AMI system of care improved the access of the population to proper treatment, thus reducing AMI in-hospital mortality.