Key result
The implementation of the AUGE universal health coverage system in Chile was associated with improved 1-year survival after acute myocardial infarction (96% vs 92%; HR 0.50, 95% CI 0.31-0.82, P=0.003).
Why the study?
Does the implementation of a universal system of health guarantees (AUGE) improve 1-year survival in patients with acute myocardial infarction?
Cohort (n=2,401)
Yes
Does the implementation of a universal system of health guarantees (AUGE) improve 1-year survival in patients with acute myocardial infarction?
Hazard Ratio: 0.5 (95% CI 0.31–0.82)
Absolute Event Rate: 96% vs 92%
p-value: p=0.003
The implementation of universal health coverage guarantees in Chile was associated with increased use of evidence-based therapies and a significant improvement in 1-year survival after acute myocardial infarction.
May support universal coverage evaluations; hypothesis-generating and should not yet change practice.
UNLABELLED: In 2005, Chile implemented a universal system of health guarantees (AUGE) aimed at improving equitable access to quality medical care for priority health conditions, including acute myocardial infarction (MI). OBJECTIVE: To evaluate 1-year survival in MI patients before and after AUGE. METHODS: Retrospective cohorts of patients with MI (with and without ST segment elevation) discharged alive from six public hospitals between January 2001-June 2005 (pre-AUGE) and July 2008-March 2009 (post-AUGE). Chilean national mortality and MI Registry (hospital-based) databases were linked using a unique identification number (ICD-10 codes I00-I99 were used to identify cardiovascular deaths). One-year survival was assessed using Weibull multivariate regression. RESULTS: About 1867 patients were discharged alive pre-AUGE and 534 post-AUGE; 25% were women in both periods. When comparing pre-AUGE and post-AUGE, there was an increase in the use of primary and elective angioplasty (1.7 vs 23.6% and 7.3 vs 20.0%), beta-blockers (62 vs 71%) and statins (40 vs 90%); P < 0.001 all. One-year survival was 92% pre-AUGE (95% CI: 91-93%) and 96% post-AUGE (95% CI: 94-97%) (HR = 0.50, 95% CI: 0.31-0.82; P = 0.003). The post-AUGE improvement persisted after adjusting for variables associated with long-term case-fatality (HR = 0.44, 95% CI: 0.26-0.75). Percutaneous coronary intervention (HR = 0.31, 95% CI: 0.09-0.99) and statins use at discharge (HR = 0.45, 95% CI: 0.31-0.66) had the highest effects associated with lower case-fatality and both treatments increased in the post-AUGE period. CONCLUSIONS: The implementation of AUGE in Chile appears to have contributed to improved treatment of MI in public hospitals and increased 1-year survival, which is consistent with its aim to improve access to quality medical care and to reduce health inequities.
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Nazzal et al. (2015) conducted a cohort in Acute myocardial infarction (n=2,401). Universal system of health guarantees (AUGE) implementation vs. Pre-AUGE period was evaluated on 1-year survival (HR 0.50, 95% CI 0.31-0.82, p=0.003). The implementation of the AUGE universal health coverage system in Chile was associated with improved 1-year survival after acute myocardial infarction (96% vs 92%; HR 0.50, 95% CI 0.31-0.82, P=0.003).
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