The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: a 6-year cohort study

Norberto L Cabral, Selma Franco, Alexandre Longo, Carla Moro, Talita A Buss, Daniel Collares, Roberta Werlich, Danieli D Dadan, Cristiane S Fissmer, Ana Aragão, Priscilla Ferst, Felipe G Palharini, Jose Eluf-Neto, Luiz A M Fonseca, William N Whiteley, Anderson R R Gonçalves

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care.

METHODS: From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units.

RESULTS: In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%.

CONCLUSIONS: FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.

Original languageEnglish
Pages (from-to)e90-5
JournalAmerican Journal of Public Health
Volume102
Issue number12
DOIs
Publication statusPublished - Dec 2012

Keywords

  • Aged
  • Brazil
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Male
  • Myocardial Infarction
  • National Health Programs
  • Program Evaluation
  • Proportional Hazards Models
  • Recurrence
  • Regression Analysis
  • Risk Factors
  • Stroke

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