Prevalence and economic impact of acute myocardial infarction in the brazilian public health system: care and economic analysis and the impacts of the Coronavirus disease


  • Gustavo Martini Buso
  • Juliano Gasparetto
  • Kleberson Rodrigues Massaro
  • Tiago Zequinão
  • Thyago Proença de Moraes
  • Felipe Francisco Tuon
  • June Alisson Westarb Cruz



health management, public health system, acute myocardial infarction, cardiology, COVID-19


Introduction: This study aimed to describe the general and specific context of hospitalizations for acute myocardial infarction (AMI) in the Brazilian public health system and its main indicators of cost-effective care in the period before and during the coronavirus (COVID-19) pandemic. Method: The main assistance and economic indicators of care related to AMI were evaluated, along with the Brazilian public health system, from January 2011 to April 2021, comparing the pre-covid indicators and those during the pandemic. The research data were descriptive and exploratory, using data from the Ministry of Health. The main data evaluated were lethality, number of hospitalizations, average length of stay and hospitalization costs. The ARIMA and general regression models were used to analyze the monthly outcomes pre and during COVID-19, thus enabling changes in the care and economic behavior of AMI cases in the public health system. Results: Hospitalization for AMI has increased over the last 10 years, with a slight decrease during COVID-19. There was an equally slight increase in lethality, with a significant decrease in the mean length of stay of hospitalized patients. The economic aspects of IAM show that more than US$ 762 million were invested during the reporting period. The average ticket presents a clear decrease in investment per capita, with a real devaluation of 70.04% in the period from 2011 to April 2021, which may be related to two main hypotheses: (1) increased effectiveness and (2) cost analysis of the effectiveness of care and/or chronic underfunding of the Brazilian public health system. Conclusion: There was a historical increase in hospitalizations and a reduction in IAM-related deaths.


IBGE. 2021. Accessed 10 July 2021.

IPEADATA. Data base Brazil. 2021. Accessed 17 July 2021.

PAIM J, TRAVASSOS C, ALMEIDA C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet, 377:1778-1797. 2011; doi:10.1016/S0140. DOI:

ROCHA R, ATUN R, MASSUDA A, Rache B, Spinola P, Nunes L, Lago M, Castro MC. Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. The Lancet. Global Health, 9:e782-e792. 2021; doi: 10.1016/S2214-109X(21)00081-4. DOI:

CASTRO MC, MASSUDA A, ALMEIDA G, Menezes-Filho NA, Andrade MV, de Souza Noronha KVM, Rocha R, Macinko J, Hone T, Tasca R, Giovanella L, Malik AM, Werneck H, Fachini LA, Atun R. Brazil’s unified health system: the first 30 years and prospects for the future. The Lancet, 394:345-356. 2019; doi: 10.1016/S0140-6736(19)31243-7. DOI:

CRUZ JAW, CUNHA MAVC, MORAES TP, Tuon FF, Linhares GP, Gomide AL, Marques S, Brazilian Private Health System. History, scenarios, and trends. BMC Health Services Research. 2022. doi: DOI:

BATISTA AM, CRUZ JAW, PICCOLI PGR. Insolvency model applied to medical cooperative organizations: Brazilian market analysis. Management Magazine & Cooperative Organizations. 2020; doi: 10.5902/2359043240561. DOI:

Brazilian federation of hospitals. Scenarios of hospitals in Brazil. 2020. Accessed 01 June 2021.

ANAHP. Sector analysis. 2021. Accessed 01 August 2021.


AGO. Trading economics. Data base Brazil. Accessed. 2021. 01.

CHAVES VM, ZDZIARSKI AD, CRUZ JAW, Silva WV, Silva CL. Efficiency analysis of the unified health system service in Paraná municipalities. Journal of Globalization, Competitiveness & Governability. 2017; doi: 10.3232/GCG.2017.V11.N2.02. DOI:

BRAZIL. MINISTRY OF HEALTH. SUS Date. Tabnet Health Information. 2021. Accessed 05 August 2021.

THE LANCET. COVID-19 in Brazil: “So what?” In. Lancet, 395. 2020; doi: DOI:

VIEIRA JL, SOBRAL MGV, FLORÊNCIO RS, Alves VM, Vasconcelos GG, Almeida GPL, Marinho LLE, Fernandes JR, Mejia JAC, Neto JDS. Lessons learned by a multidisciplinary heart failure clinic in the midst of A pandemic. ABC Feart Failure & Cardiomyopathy. 2021; doi: 10.36660/abchf.20210012. DOI:

LOESCH GH, CRUZ JAW, GASPARETTO J, Oliveira DDS, Telles JP, Tuon FF. Cost minimization analysis of outpatient parenteral/oral antibiotic therapy at a trauma hospital: public health system. Infection Control & Hospital Epidemiology:1-6. 2021; doi: 10.1017/ice.2021.22. DOI:

GASPARETTO J, TUON FF, DOS SANTOS OLIVEIRA DS, Zequinão T, Pipolo GR, Ribeiro GV, Benincá PD, Cruz JAW, Moraes TP. Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC Infectious Diseases, 19:650. 2019; doi: 10.1186/s12879-019-4280-0. DOI:

MORENO E, VÁZQUEZ-POLO FJ, NEGRÍN-HENÁNDEZ MA. Cost-Effectiveness Analysis of Medical Treatments. Boca Raton: CRC Press. 2019. DOI:

LOESCH G, CRUZ JAW, PECOITS-FILHO R, Figueiredo AE, Barretti P, de Moraes TP. Public health investments and mortality risk in Brazilian peritoneal dialysis patients. Clinical Kidney Journal, 13:1012-1016. 2020; doi: 10.1093/ckj/sfaa118. DOI:

RODRIGUES KM, CRUZ JAW, VALE RR, Moraes SC, Kato HT, Weymer ASQ. The effect of volunteer work in hospitals In Interdisciplinary Journal of Social Management a Brazilian University Hospital. 2021.

IBGE. Sociodemographic and health indicators in Brazil. 2009. Accessed 05 July 2021.

TUON FF, PEPES A, OLIVEIRA DDS, Zequinão T, Cruz JAW, Telles JP. Cost-minimization in Health: linezolid versus vancomycin with serum monitoring in patients with incipient renal failure - a simulation and real-life. Brazilian Journal of Health Review, 4:17974-17987. Jul/Aug 2021. DOI: DOI:

BROMAGE DI, CANNATÀ A, RIND IA, Gregorio C, Piper S, Shah AM, McDonagh TA. The impact of COVID-19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic. European Journal of Heart Failure, 22:978-984. 2020 Jun. doi: 10.1002/ejhf.1925. Epub 4 July 2020. PMID: 32478951; PMCID: PMC7300902. DOI:

SEVERINO P, D’AMATO A, SAGLIETTO A, D’Ascenzo F, Marini C, Schiavone M, Ghionzoli N, Pirrotta F, Troiano F, Cannillo M, Mennuni M, Rognoni A, Rametta F, Galluzzo A, Agnes G, Infusino F, Pucci M, Lavalle C, Cacciotti L, Mather PJ, Grosso Marra W, Ugo F, Forleo G, Viecca M, Morici N, Patti G, De Ferrari GM, Palazzuoli A, Mancone M, Fedele F. Reduction in heart failure hospitalization rate during coronavirus disease 19 pandemic outbreak. ESC Heart Failure, 7:4182-4188. 2020 Oct 23. doi: 10.1002/ehf2.13043. Epub ahead of print. PMID: 33094929; PMCID: PMC7754919. DOI:

CRUZ JAW, BUSO GM, MOURA LAZ, MORAES TP, CUNHA MAVC, ZEQUINÃO T, GASPARETTO J, TUON FF, MARQUES S. Brazilian Public Health System: history and profile of heart failure care and the impacts of COVID-19. Jornal Brasileiro de Economia em Saúde, 14 (2), 2022. doi: 10.21115/JBES.v14.n2.p140-148 . In: DOI:




How to Cite

BUSO, G. M.; GASPARETTO, J.; MASSARO, K. R.; ZEQUINÃO, T.; DE MORAES, T. P.; TUON, F. F.; CRUZ, J. A. W. Prevalence and economic impact of acute myocardial infarction in the brazilian public health system: care and economic analysis and the impacts of the Coronavirus disease. Journal Archives of Health, [S. l.], v. 4, n. 1, p. 16–32, 2023. DOI: 10.46919/archv4n1-003. Disponível em: Acesso em: 17 jun. 2024.