Cardiac surgeons accuse Queiroga of benefiting hemodynamics in an ordinance

An ordinance by the Ministry of Health that readjusts values ​​in the treatment of acute myocardial infarction only for hemodynamics, the area of ​​expertise of minister Marcelo Queiroga, is causing controversy among cardiovascular surgeons.

In a note published on its website and on social networks, the SBCCV (Brazilian Society of Cardiovascular Surgery) expresses concern that procedures such as revascularization surgery (saphenous bypass), indicated for the most serious cases of heart attack, have been left out of the ordinance.

In an interview with leaf, the president of the SBCCV, surgeon Eduardo Rocha, says that, by approving an ordinance that only privileges hemodynamics, Queiroga incurs an evident conflict of interests.

“The minister is mixing public interest with personal interest. We surgeons are outraged. We have not had an increase since 2009,” he says.

According to him, a team of five cardiovascular surgeons receives R$ 2,800 to perform a coronary bypass. “It’s 500 bucks, 600 bucks each to take care of a patient for 12 days, on average. Here comes the minister and creates benefits just for his group?”, he says.

Ordinance 3,438, published on December 7, provides for a series of actions in the line of care for infarction care, such as updating and readjusting the table of procedures, medications, orthotics, prostheses and special materials in the area of ​​hemodynamics.

There are three types of infarction: the mildest and without obstruction in the coronary artery, which, in general, only requires clinical treatment; others with changes in the electrocardiogram that will need an angioplasty (stent) or thrombolysis (a drug that dissolves the clot and leaves the coronary artery open); and those requiring coronary artery bypass surgery.

“They are the most serious patients, the ones who die the most and who will be left out of the ordinance. They are patients with more than two or three lesions in the coronary arteries, they rupture the ventricle and bleed, whose valves are torn by the infarction. It is necessary to look at the line from care to heart attack from beginning to end.”

Rocha says that cardiovascular surgery is experiencing an unprecedented crisis in the SUS (Unified Health System), without basic supplies, and that it got worse with the lack of assistance caused by the Covid-19 pandemic.

At least 60,000 procedures were not carried out this year. Before the health crisis, about 100,000 were carried out a year, 60% to 70% of them in the SUS.

“We are not getting material from the SUS. Several hospitals only operate in emergencies. The minister is informed about all this and has barely received us. And now he only gives raises for one of the parts of the heart attack care line? For your peers? What he did is meaningless, if the meaning is the ethics of the treatment.”

Since January of this year, there is a lack of materials such as heart valves, oxygenators and cannulas, necessary for bypass surgery, correction of congenital defects in adults and children, and valve replacements.

SUS pays hospitals less than R$6,000 to cover the entire cost of heart surgery. The average stay in the ICU is three days and at least one week of hospitalization. Hospitals estimate that each heart surgery performed in SUS results in a loss of R$2,000 on average.

“Hospitals look at us, surgeons, as a financial danger for them,” says the president of the SBCCV.

Other side

The Ministry of Health said, in a note, that the ordinance “establishes that the treatment of thrombolysis/primary angioplasty is carried out by an interventionist and not by a cardiovascular surgeon”.

According to the folder, acute myocardial infarction (AMI) is among the two main causes of death in Brazil and worldwide.

“Acute coronary artery occlusion by thrombus, usually superimposed on an area affected by atherosclerotic plaques, is the determining event of acute myocardial infarction. The modern treatment of AMI depends on the use of reperfusion therapies, rapid access to medical service and use of specific medications with proven benefit,” said the folder.

Also according to the ministry, “the use of thrombolytic drugs has been shown to have a positive impact on health outcomes, minimizing the impacts of the acute event on functional capacity and reducing mortality”.

The ministry concludes the note saying that the redefinition of actions also included measures related to strengthening early diagnosis, reperfusion therapies and encouraging cardiovascular rehabilitation.