Abstract
BackgroundLittle is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality.Methods and resultsUsing data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing.From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.ConclusionsThe majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.
Highlights
Acute coronary syndrome (ACS) and other forms of cardiovascular disease remain one of the leading causes of death and morbidity worldwide, currently accounting for one of every three deaths [1]
From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million US dollars (USD)
The majority of testing for acute coronary syndrome (ACS) in Brazil is conducted at referral centers in developed urban settings
Summary
Acute coronary syndrome (ACS) and other forms of cardiovascular disease remain one of the leading causes of death and morbidity worldwide, currently accounting for one of every three deaths [1]. Diagnostic evaluation is typically a combination of electrocardiogram (ECG), laboratory testing (troponin, CK-MB), cardiac catheterization, and functional testing, which is commonly referred to as the stress test [2]. Despite the widespread use of stress tests, there has been a resurgent debate over the proper role of stress testing in the evaluation of patients with possible ACS: some have argued that stress testing provides valuable prognostic information and risk-stratification in appropriate patients while others have argued that stress testing can produce both false positive and false negative results and does not reduce mortality [6, 7]. Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality
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