“Community Cardiology Model Implemented in a Public Step-Down ICU: Reducing Mortality and Readmissions in Rural”
“Community Cardiology Model Implemented in a Public Step-Down ICU: Reducing Mortality and Readmissions in Rural”
DOI:
https://doi.org/10.51473/rcmos.v1i1.2025.945Keywords:
community cardiology; cardiovascular mortality; clinical protocol; public health; step-down intensive care.:** cardiologia comunitária; mortalidade cardiovascular; protocolo clínico; saúde pública; unidade semi-intensiva.Abstract
Background: Cardiovascular diseases (CVDs) remain the leading cause of death in Brazil, especially in rural areas with limited infrastructure and specialist shortages. Objective: To assess the impact of a structured community-based cardiology model implemented in the Step-Down Intensive Care Unit (SD-ICU) of Tomaz Martins Municipal Hospital (Santa Inês, Maranhão) on mortality, length of stay and clinically stable discharge. Methods: Retrospective, quantitative and descriptive observational study including a census of 1,148 patients admitted between 2015 and 2020. Results: Cardiovascular mortality decreased by 27 %, mean length of stay fell from 8.4 ± 2.1 to 5.6 ± 1.4 days, and clinically stable discharges rose to 89 %. Conclusion: Standardised clinical protocols combined with continuous medical leadership can markedly improve outcomes in medium-complexity public services.
Downloads
References
SOCIEDADE BRASILEIRA DE CARDIOLOGIA. Diretriz de prevenção
cardiovascular da SBC – 2022. Arq Bras Cardiol, v. 118, supl. 1, p. e1-e138,
WORLD HEALTH ORGANIZATION. Cardiovascular diseases (CVDs). Geneva:
WHO, 2023. Disponível em:
https://www.who.int/news-room/fact-sheets/detail/cardiovascular-disease
s-(cvds). Acesso em: 10 abr. 2025.
INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. Estatísticas de
saúde: assistência médico-sanitária. Rio de Janeiro: IBGE, 2022.
MINISTÉRIO DA SAÚDE (Brasil). DATASUS – Informações de Saúde (TABNET).
Brasília, 2023. Disponível em: http://www2.datasus.gov.br/DATASUS. Acesso
em: 15 abr. 2025.
STARFIELD, B.; SHI, L.; MACINKO, J. Contribution of primary care to health
systems and health. Milbank Quarterly, v. 83, n. 3, p. 457-502, 2005.
WHELLAN, D. J. et al. End-of-life care in patients with heart failure. Journal of
Cardiac Failure, v. 20, n. 2, p. 121-134, 2014.
PORTER, M. E. What is value in health care? New England Journal of Medicine,
v. 363, n. 26, p. 2477-2481, 2010.
TRICCO, A. C. et al. Effectiveness of quality improvement strategies on the
management of diabetes: a systematic review and meta-analysis. Lancet,
v. 379, n. 9833, p. 2252-2261, 2012.
BRITISH HEART FOUNDATION. National Audit of Cardiac Rehabilitation –
Annual Statistical Report 2021. London: BHF, 2021.
TU, J. V. et al. Effectiveness of public report cards for improving the quality of
cardiac care: the EFFECT study. JAMA, v. 298, n. 19, p. 2330-2341, 2007.
McKELVIE, R. S. et al. Integrated heart failure care reduces mortality: a
randomized trial. Circulation, v. 140, n. 4, p. 123-131, 2019.
LEE, D. S.; LI, P.; TU, J. V. Reduction in heart failure readmissions with
integrated care. Canadian Journal of Cardiology, v. 34, n. 8, p. 1027-1035, 2018.
HOBBS, F. D. R. et al. Community heart failure pathways in the NHS: outcomes
after five years. Heart, v. 106, n. 12, p. 934-941, 2020.
SAMPAIO, M. E.; ALMEIDA, R. T.; ARAÚJO, W. Impacto de protocolos clínicos
em hospital regional do Piauí. Revista Brasileira de Cardiologia, v. 34, n. 2,
p. 115-122, 2021.
SOUZA, A. C.; BARRETO, M. L. Desempenho do HIPERDIA-SUS na redução de
AVC. Cadernos de Saúde Pública, v. 36, n. 7, p. e00234519, 2020.
Downloads
Additional Files
Published
Issue
Section
Categories
License
Copyright (c) 2025 Marcelo Martins Bringel Carvalho (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This means you are free to:
- Share — copy and redistribute the material in any medium or format.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
The use of this material is conditioned upon proper attribution to the original author(s), providing a link to the license, and indicating if changes were made. The license does not require permission from the author or the publisher as long as these conditions are met.
The Creative Commons license logo is displayed permanently in the footer of the journal.
The copyright of the manuscript can be retained by the authors without restrictions and can be requested at any time, even after publication in the journal.
How to Cite
