Browsing by Author "Pinto, Armando Teixeira"
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- A comparison of in-hospital acute myocardial infarction management between Portugal and the United States : 2000–2010Publication . Lobo, Mariana F.; Azzone, Vanessa; Azevedo, Luís Filipe; Melica, Bruno; Freitas, Alberto; Nicolau, Leonor Bacelar; Gonçalves, Francisco N. Rocha; Nisa, Cláudia; Pinto, Armando Teixeira; Miguel, José Pereira; Resnic, Frederic S.; Pereira, Altamiro Costa; Normand, Sharon-LiseObjective: To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. Design: Repeated cross-sectional retrospective cohort study. Setting: Acute care hospitals in Portugal and USA during 2000-2010. Participants: Adults discharged with AMI. Interventions: Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). Main Outcome Measures: In-hospital mortality and length of stay. Results: We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. Conclusions: Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
- Picturing inequities for health impact assessment : linked electronic records, mortality and regional disparities in PortugalPublication . Nicolau, Leonor Bacelar; Rodrigues, Teresa; Fernandes, Elisabete; Lobo, Mariana F.; Nisa, Cláudia Fernandes; Azzone, Vanessa; Pinto, Armando Teixeira; Pereira, Altamiro Costa; Normand, Sharon-Lise Teresa; Miguel, José PereiraHealth impact assessment (HIA) focuses on minimizing inequities when studying the effects of a policy on the population’s health. Nevertheless, it is seldom simultaneously quantified, multivariate, and visually graphically comprehensible for non-statisticians. This paper aims to address that gap, assessing a policy promoting the quality of Electronic Health Records, linking hospital and primary health care data (Blood Pressure, Cholesterol, Triglycerides, Waist Circumference, Body Mass Index) to mortality outcomes and regional inequities. Acute Myocardial Infarction patients admitted in the hospital are then followed regularly in Portuguese NHS Primary Care. Regional disparities regarding recorded information are observed and different association patterns with mortality identified, ranked, and visualized through adjusted ORs for sex, age, and indicators of severity of hospital admission, complemented with multivariate correspondence analysis. A pathway to handling equity within quantitative HIA shows that complexity in data and methods may generate simplicity and clarity through visual graphical aids. Tackling Big Data with Data Science in HIA may even be at the center of future health reforms, assessing impacts of health promotion and chronic disease policies.
- The Atlantic divide in coronary heart disease : epidemiology and patient care in the US and PortugalPublication . Lobo, Mariana F; Azzone, Vanessa; Resnic, Frederic S; Melica, Bruno; Pinto, Armando Teixeira; Azevedo, Luís Filipe; Freitas, Alberto; Nisa, Cláudia; Nicolau, Leonor Bacelar; Gonçalves, Francisco Nuno Rocha; Miguel, José Pereira; Pereira, Altamiro Costa; Normand, Sharon-LiseIntroduction and Objectives: We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. Methods: We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. Results: Relative to the US, Portugal has lower risk profiles and less than halfthe hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused fasterin the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100 000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. Conclusions: Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions.