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Observational Study
. 2019 Jan 10;14(1):e0210502.
doi: 10.1371/journal.pone.0210502. eCollection 2019.

The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access

Julian T Hertz  1 , Tommy Fu  1 , Joao Ricardo Vissoci  2   3 , Thiago Augusto Hernandes Rocha  4 , Elias Carvalho  5   6 , Brendan Flanagan  1 , Luciano de Andrade  7 , Alex T Limkakeng  1 , Catherine A Staton  1   2
Affiliations
Observational Study

The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access

Julian T Hertz et al. PLoS One. .

Abstract

Background: Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality.

Methods and results: Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.

Conclusions: The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Brazilian regions and municipality income levels.
Fig 2
Fig 2. The distribution of hospitals performing cardiac diagnostic testing and the distribution of population density in Brazil.
Fig 3
Fig 3. Distribution of cardiac diagnostic testing rates and ACS mortality rates in Brazil, 2008–2014 (per 100,000 persons).
Fig 4
Fig 4. Geographic variation in access to cardiac diagnostic testing in Brazil.
Fig 5
Fig 5. Coefficients of geographic weighted regression of income and accessibility indices of cardiac diagnostic testing as predictors of ACS mortality in Brazil, 2008–2014.
See this image and copyright information in PMC

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