Os desafios na adesão às metas da diretriz nacional de atendimento a pacientes com síndrome coronariana aguda em um centro especializado em cardiologia no Pará

Abstract

Acute Coronary Syndrome generates excessive costs in the national health system, in addition to representing a disease of high incidence and great impact in terms of morbidity and mortality. The identification and understanding of extra and in-hospital factors that influence the prognosis are extremely important to improve the care of patients with Acute Coronary Syndrome (ACS). This project aimed to evaluate the time between the onset of symptoms, the time to perform the in-hospital diagnostic and therapeutic measures and the prognosis of patients with acute coronary syndrome in a reference hospital in cardiology in Belém-PA and compare with the established goals by the V Guideline of the Brazilian Society of Cardiology on the Treatment of Acute Myocardial Infarction with ST-Segment Elevation. Data from the Good Practices in Cardiology Program, in which the Hospital de Clinicas Gaspar Vianna participates, from 2017 to 2020 are used. The data were represented in Microsoft Excel tables and analyzed using the Biostat 5.0 program. Results: Men were more affected with ACS (74%), the most prevalent age was 50 to 69 years (62%). Most patients came from UPAS (Emergency Care Units) (39%), followed by their own residence (22%) and transferred from another hospital (18%). The time to seek care for the majority was between 4 and 8 hours (36.9%), the time to perform the electrocardiogram was less than 10 minutes in 54.2% of the patients and the door-to-balloon time was less than 90 minutes in 51.8%, between 90 and 120 minutes in 23.4% and greater than 120 minutes in 24%. Correlating the ejection fraction (EF) with the time until arrival at the service, it was found that regardless of the final EF, the search for the health service took place between 4 to 8 hours. It was also found that patients with severely decreased ejection fraction (<30%) sought, for the most part (60%), more than 8 hours for care. In the association between time to angioplasty and ejection fraction, 52.9% of patients with EF > 40% underwent catheterization within 90 minutes. The percentage of patients between 90 and 120 minutes and greater than 120 minutes was, respectively, 28.8% and 24.2%. It is concluded that several factors are interconnected in order to reach the best times until seeking care, establishing the diagnosis and starting therapy, resulting in benefits for myocardial viability in patients with ACS, according to the efficiency of these factors. Thus, compliance with the goals established by national guidelines is essential for the pursuit of excellence in care.