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Disparities in access and three-year survival of patients with ST-elevation myocardial infarction treated in percutaneous coronary intervention-capable hospitals within the Brazilian public and private healthcare systems: The VICTIM extended registry.

Ticiane Clair Remacre Munareto Lima, Jussiely Cunha Oliveira, Jeferson Cunha-Oliveira, Ikaro Daniel de Carvalho Barreto, Marcos Antônio Almeida-Santos, Laís Costa Souza Oliveira, Larissa Andreline Maia Arcelino, Luiz Flávio Andrade Prado, Fábio Serra Silveira, Thiago Augusto da Silva Nascimento and 9 more

Public Health · 2026-02-23 · Observational study

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Abstract

OBJECTIVES: Disparities in the management and outcomes of ST-segment elevation myocardial infarction (STEMI) between public and private healthcare sectors are a critical concern in middle-income countries. In Brazil, national data on long-term survival and quality of STEMI care are limited. This study compared access to care, treatment strategies, and three-year survival among STEMI patients treated in Brazil's public and private healthcare system. STUDY DESIGN: Prospective cohort study. METHODS: Data were derived from the VICTIM Registry, enrolling 1082 STEMI patients admitted to all percutaneous coronary intervention (PCI)-capable hospitals in Sergipe, Northeast Brazil, from 2014 to 2018. Patients were stratified by healthcare sector: public (Sistema Único de Saúde, SUS) or private. Clinical characteristics, access to care, treatments, and three-year survival were assessed. Cox proportional hazards models estimated hazard ratios (HRs) for mortality, adjusted for demographic and clinical variables. RESULTS: 82.5 % were treated in the public sector. SUS patients experienced longer pre-hospital delays (median 10.3 vs. 5.2 h; p < 0.001), lower reperfusion rates (49.8 % vs. 67.2 %; p < 0.001), and suboptimal use of guideline-recommended medications. Over a median follow-up of 38.9 months, mortality was higher in the SUS group (31.2 % vs. 21.2 % adjusted HR 1.43, 95 % CI 1.21-1.69; p = 0.001). Even among patients receiving reperfusion, SUS patients had higher mortality than those in the private sector. CONCLUSIONS: Our findings reveal significant disparities in STEMI management and long-term survival between Brazil's public and private healthcare sectors. Strengthening emergency networks, expanding access to reperfusion, and improving adherence to guidelines are essential to reduce mortality in public healthcare settings.

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Tags

Equity & disparities · Low- and middle-income settings · Mortality & survival · Time intervals

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