The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: A 6-year cohort study

Abstract

Objectives: We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care. Methods: From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units. Results: In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85;95% confidence interval [CI] = 0.61, 1.18; P =.39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68;95% CI = 0.50, 0.92; P =.01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P =.005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%. Conclusions: FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.