ABC | Volume 113, Nº2, August 2019

Original Article Lima et al The VICTIM register- Intra-hospital counseling Arq Bras Cardiol. 2019; 113(2):260-269 benefits associated with the reduction of important cardiovascular outcomes. 11-15 Quality indicators and guidelines related to AMI recommend that these dietary changes must be guided by health professionals, even still during the in-hospital period. This contributes to the empowerment of the individual, and provides greater awareness of his role in relation to his own health, in addition to guiding his food choices, and increasing his nutritional knowledge. 7,9,16-20 Previous studies demonstrated the existence of disparities in the quality of care between public and private health services, related to the time to perform examinations, and the use of cardiovascular medications. 21,22 This finding is concerning because approximately 72% of the Brazilian population is exclusively dependent on the Unified Health System (SUS). 23 However, the type of care provided by health professionals regarding nutritional counseling is poorly explored, and possible differences in the quality of this orientation in the in-hospital environment between the two health services are not yet known. Thus, the present study aims to evaluate the quality of nutritional counseling received in the in-hospital environment in patients with ST-segment elevation myocardial infarction (STEMI) receiving care in the public and private health services in Sergipe. Methods This was a cross-sectional, quantitative study which used data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, which aims to evaluate the quality of care provided to patients with STEMI in the public and private health systems in Sergipe. Data collection occurred from April to November of 2017, in the only four hospitals in the state with the capacity to perform primary angioplasty, all located in the Aracaju capital, one with SUS coverage and three with private coverage. Patients of both sexes, older than 18 years of age, with a STEMI diagnosis confirmed by electrocardiogram were included, according to the defining criteria proposed by the Brazilian Society of Cardiology. 24 Individuals excluded were those who: died prior to concluding all stages of the study; did not meet the Via Crucis criteria, that is, those patients who did not travel the course from the beginning of the symptoms until arrival at the hospital with the ability to perform angioplasty, because they were already in the hospital when they experienced the STEMI; did not agree to participate in some stage of the research; those whose acute STEMI event was characterized as reinfarction (occurred within 28 days of the primary infarction); presented a change of diagnosis during hospitalization; were funded by private health insurance in a philanthropic hospital; and, were unable to be contacted by telephone within seven days after hospital discharge. This research was approved by the Research Ethics Committee of the Federal University of Sergipe (UFS), under opinion nº 2,099,430. All procedures involved in this study are in accordance with the Declaration of Helsinki of 1975, updated in 2013. All patients signed the Terms of Free and Informed Consent form. The data collection was performed in two stages: in the hospital environment and after discharge by telephone interview. In the hospital, a study instrument was used, the Case Report Form (CRF), which is composed of sociodemographic variables, previous pathological history, cardiovascular risk factors, physical examination on admission, and nutritional counseling recorded in the clinical patient records. The second stage of the research occurred via telephone contact with the patients, within seven days after hospital discharge; this interval was determined after the pilot study and pondered the need for an immediate interview with them. At that time, the occurrence of nutritional counseling during the hospital period was evaluated, even though it was not recorded in the patient records by the health professional. In addition, the National Health Interview Survey Cancer Epidemiology was administered, a nutritional knowledge scale adapted for the present study. 25 At this moment in time, the quality of in-hospital nutritional counseling was also assessed, using a closed‑ended questionnaire based on the items proposed in the guidelines. 9,18,26,27 The categories of responses were "oriented", "not oriented", and "do not know". The presence or absence of a recommendation on physical activity after AMI, as established in the aforementioned guidelines, was also observed. The nutritional status of the patients was obtained using the Body Mass Index (BMI), calculated by means of the body mass (weight) (kg) divided by the square of the body height (m²), and classified according to the cutoff points proposed by the WHO. 28 Statistical analysis The Kolmogorov-Smirnov test was applied to evaluate the assumption of sample normality. Continuous variables that presented a normal distribution were described using mean and standard deviation; those that did not present a normal distribution were represented using median and interquartile range. The Student's t-test or the Mann-Whitney test was used for the independent groups, based on the normality standard of the sample. Absolute frequency and percentage were used for the categorical variables. To compare characteristics of the categorical variables between the two groups, the chi-square test or the Fisher's exact test were used, when appropriate. The significance level of 5% was used as a reference. A sampling plan was established in order to detect differences in the magnitude of mean between public and private health service samples. A significance of 1% and a power of 90% were established for comparisons between these two groups. Non-parametric tests were also used, and in order to obtain the same test power, a correction of 0.86429 was established. 29   In the data collection, the final sample remained similar in proportion to what was initially established (X² = 0.01, p = 0.912), preserving the initial conditions of power, level of significance, and design, as well as preserving the initial intention for detecting differences of mean magnitude between the two groups (public vs. private). The SPSS for Windows program, Version 17, was used for statistical analysis. 261