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Introdução à Medicina I Class 11 Adviser : Dr. Armando Teixeira Pinto. Faculdade de Medicina da Universidade do Porto Curso de Mestrado Integrado em Medicina 2008/2009. Comparison and Evolution of Medical Care of Inpatients with Acute Myocardial Infarction in Portuguese Public Hospitals.

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introdu o medicina i class 11 adviser dr armando teixeira pinto

Introdução à Medicina IClass 11Adviser: Dr. Armando Teixeira Pinto

Faculdade de Medicina da Universidade do Porto

Curso de Mestrado Integrado em Medicina



Comparison and Evolution of Medical Care of Inpatients with Acute Myocardial Infarction in Portuguese Public Hospitals

Faculdade de Medicina da Universidade do Porto



Background and Justification

  • Acute myocardial infarction (AMI – ICD9 410) is one of the major causes of death among Western civilization.
  • Such studies are not widespread among Portuguese institutions
  • Access to hospitals’ admnistrative data.
  • Understandingthe general qualityconcerningthetreatmentof AMI inPortuguesePublicHospitals.
  • Itmaycreatetheneed for improvement.
  • Stimulatingfurtheranalysisandfuturestudies.
  • Providing a guide for general population.
acute myocardial infarction ami
AcuteMyocardialInfarction (AMI)
  • Medical term for heart attack.
  • Caused by the blockage of the coronary arteries which will lead to an insufficient blood suply to the heart muscle (myocardium).
research question and aims
Research Question and Aims


  • What is the status of medical care system in Portugal for AMI and how has it evolved throughout the years?
  • What is the geographical distribution of AMI incidence in mainland Portugal?


  • Compare different Portuguese areas according to 2 criteria
  • Compare hospitals’ quality based on 2 criteria.
  • Evaluatetheimprovementsofmedicalcareinhospitals.
sample evolution

Total number of admissions with AMI, fatality rate and median length of stay in the hospital, per year of admission (total n= 91133)



Fatality/Survival rate

participants and methods study design
Participants and Methods Study Design
  • Transversal and longitudinal Study
  • Data: fromallPortuguesePublicHospitals, from 2000 to 2007.

Participants and MethodsData and Variables

  • Variables:
    • Number of admissions;
    • Lenght of Stay;
    • Fatality rate:

FR = Number of deaths caused by AMI

Number of Admissions by AMI

Extract of the database’s codes

hospitals classification
Hospitals’ Classification
  • According to the newest hospital classification:
      • Central hospitals– Including the main hospitals of the main regions in Portugal;
      • Distrital hospitals– Including the main hospitals of secondary regions in Portugal;
      • Level 1 distrital hospitals – Including the smallest hospitals.

Sampleused for comparison

  • Bytypeof hospital
    • Numberofadmissions
    • Fatality / Survival Rates
    • Lengthofstay
  • Central hospitals
    • Fatality rate
    • Lengthofstay
  • Distrital hospitals
    • Fatality rate
    • Lengthofstay
  • Level 1 distrital hospitals
    • Fatality rate
    • Lengthofstay
comparison by type of hospital
Comparisonbytypeof hospital


Fatality rate



---- Median length of stay

___ Fatality rate

The evolution of fatality rates and median length of stay throughout the years, for central, distrital and level 1 distrital hospitals

    • Regarding the fatality rate:
      • No significant variation was observed for distrital and central hospitals. A slight increase was observed for type 1 distrital hospitals.
      • These results should not be linearly associated to a decrease in the quality of medical care provided as various factors could be related to this (ex: older population).
    • Regarding the length of stay:
      • a very slight decrease was observed, more evident between the years of 2000 and 2002 and between 2004 and 2006.
      • This can be connected to structural and organizational modifications in SNS hospitals, like the introduction of “Hospitais SA” in 2002 and “Hospitais EPE” in 2004.
    • As expected, there were significant differences between the three types of hospitals.
    • Admittance of an association between lower fatality rate and lower length of stay.
    • Possible indicators in the quality of care provided.
discussion limitations
  • Information relative to the year 2007 (some changes may have occured since).
  • Possible information bias in the database.
  • No information ab0ut procedures.


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