Ischemic Stroke and Acute Myocardial Infarction: Trends in in-Hospital Mortality in Brazil from 1998 to 2018

Abstract

Background: Ischemic stroke and acute myocardial infarction (AMI) are cardiovascular diseases with high morbidity and mortality rates in Brazil and worldwide. Their outcomes are influenced by public policies aimed at mitigating risk factors and by investments in infrastructure of emergency support and quality of hospital care. Objective: To analyze the trend in the proportion of in-hospital deaths from ischemic stroke and AMI in Brazil as a way of evaluating the effectiveness of urgency and emergency services. Methods: Ecological time series study using data from the Hospital Information System. The outcome was the proportion of in-hospital deaths from ischemic stroke and AMI with stratification by sex and state. Prais-Winsten regression was used to analyze the trend between 1998-2018 with α≤0,05. Results: The proportion of deaths from AMI and ischemic stroke declined in the time series (p<0.001), decreasing annually by 0.17% and 0.25%, respectively. In 20 years, it reduced 43.76% (ischemic stroke) and 32.39% (AMI) in both sexes. However, the decline was more evident in the South and Southeast regions. Conclusion: The reduction in hospital deaths from AMI and ischemic stroke was heterogeneous among Brazilian regions, which may be related to inequality in emergency services and hospital support.