IJCS | Volume 31, Nº4, July / August 2018

340 Oliveira et al VICTIM Registry Int J Cardiovasc Sci. 2018;31(4)339-358 Original Article Introduction The guarantee that health is a constitutional right and the subsequent creation of the Brazilian Unified Health System (SUS) are fundamental landmarks of the Brazilian public health. 1,2 Based on that, every Brazilian would have universal, integral and equitable access to quality healthcare. 2 Although the SUS is more than three decades old, the quality of the healthcare it provides has been insufficiently scrutinized by the Science of Results. 3 This is particularly critical because 72.1% of the Brazilian population essentially depends on SUS, and only 27.9% of the Brazilians have some other type of healthcare coverage. 4 Acute myocardial infarction (AMI) continues to be the major cause of cardiovascular morbidity and mortality in Brazil and worldwide. 5-7 In ST-segment elevation myocardial infarction (STEMI), the immediate access to reperfusion therapies increases substantially the chance of survival. 5-8 Although myocardial reperfusion for STEMI has been established since the 1980s, 9 contemporary data from several countries and regions have shown the variability and underuse of that therapy and several other pharmacological or procedural practices, essential to the treatment of patientswithSTEMI. 10-14 Developing countries, however, lack studies on the quality of the care provided to patients with AMI. In Brazil, studies investigating the quality of the healthcare provided by SUS are scarce. 3 Therefore,generatingrepresentativeandcomprehensive knowledge on the healthcare quality provided by SUS is justified, in addition to assessing the existence of disparity as compared to the healthcare quality provided by the private system, which, if confirmed, should be quantified. However, assessing the healthcare provided to patients with STEMI in the huge territory of Brazil is a challenge. To fill that gap, limiting the research field to a circumscribed geography and developing pilot projects can be the most realistic strategy. 11,12,15,16 Thus, Sergipe, by being the smallest state in Brazil, counting on only four referral hospitals specialized in cardiovascular diseases, can serve as a laboratory to measure the presumed disparity in the healthcare provided by the SUS and the private system to treat patients with STEMI. Context of the VICTIM Registry The VICTIM ( Via Crucis para o Tratamento do Infarto do Miocárdio ) Registry was designed to investigate and compare patients with STEMI cared for in the public and private health systems considering the following major objectives: 1) celerity in the search for medical care; 2) temporal and geographic course of patients, from symptom onset to search for care and access to referral hospitals specialized in cardiovascular disease; 3) demographic and clinical characteristics of the patients with STEMI referred to the centers specialized in cardiovascular disease in the State of Sergipe; 4) access to the myocardial reperfusion therapies occurring during transportation to those centers and those occurring upon arrival there; 5) to assess whether the healthcare practices of public and private health services are aligned with the metric indicators that represent hospital care quality for the management of STEMI; 6) the rate of cardiovascular events occurring in-hospital and up to 30 days from the index event. In addition, the VICTIMRegistry has the following general objectives: 7) to collaborate with the institutions participating in the process of improving the quality of the care provided to patients with STEMI; 8) to identify opportunities of improving the quality of the care provided to patients with STEMI in the entire State of Sergipe; 9) to disseminate knowledge at local and national levels; 10) to serve as a research platform for larger, multicenter and national studies; 11) to influence the public policies regarding the healthcare provided to patients with STEMI at state and national levels, in addition to other countries with similar socioeconomic characteristics. The present study describes the methodology of the VICTIMRegistry and discusses its potential implications. Domains analyzed For the outline of the VICTIM Registry, the following domains were considered (Figure 1): A. Epidemiology of STEMI at referral hospitals B. Pre-hospital healthcare quality C. Healthcare quality at the referral center D. Clinical outcomes E. Post-discharge healthcare quality History of the project Pilot projects for the VICTIMRegistrywere conducted from May 2013 to November 2014 aimed at training the data collection team and at raising awareness in each referral center about the need for studies on the healthcare quality provided to patients with STEMI.