Methods: The ERICO study is a cohort study of individuals treated for an ACS event between 2009 and 2013 in Hospital Universitário, a community hospital in the borough of Butantã, São Paulo, Brazil. Follow-up was performed at 30 days, 180 days and one year after the index event, by telephone contact. We revised data from 701 ERICO participants (87 with PC-FMC and 614 with H-FMC). We used Wilcoxon test to determine if time from FMC to the administration of aspirin, clopidogrel and heparin (in individuals with non-ST elevation ACS) and thrombolysis (in individuals with ST-elevation ACS) was different according to the FMC unit. We built Cox regression models adjusted for age, sex and ACS subtype to study if the FMC unit predicted one-year survival in the sample.
Results: Administration of aspirin, clopidogrel and heparin was almost universal (100.0%, 97.7% and 97.7% in PC-FMC and 98.5%, 96.6% and 96.4% in H-FMC groups. Individuals with non-ST elevation ACS in the PC-FMC group received aspirin earlier than in the H-FMC group (median time, 2.40 vs 2.53 hours, p<0.001). There was also a trend towards an earlier administration of aspirin in ST-elevation ACS patients in the PC-FMC group (median time, 0.70 vs 1.13 hours, p=0.075). Time to thrombolysis in ST-elevation ACS patients was non-significantly lower in H-FMC group (median time, 1.03 vs. 1.15, p=0.19). Complete vital status data was available for 669 (95.4%) participants. We had eight (9.9%) and 67 (11.4%) deaths during follow-up in the PC-FMC and H-FMC groups, respectively. FMC unit was not a predictor for one-year survival in this sample. The adjusted hazard ratio for PC-FMC was 1.03 (95% confidence interval 0.50–2.16).
Conclusions: Our findings suggest that primary care can be a suitable setting for the evaluation of acute chest pain, once timely evaluation, safe transportation and access to hospital treatment are warranted. Respecting the characteristics of local health systems, policy makers should consider to organize such strategy for the system-of-care during a suspected ACS event.