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Rural-Urban Disparities in Outcomes of Myocardial Infarction, Heart Failure, and Stroke in the United States.
- Source :
-
Journal of the American College of Cardiology (JACC) . Jan2022, Vol. 79 Issue 3, p267-279. 13p. - Publication Year :
- 2022
-
Abstract
- <bold>Background: </bold>U.S. policy efforts have focused on reducing rural-urban health inequities. However, it is unclear whether gaps in care and outcomes remain among older adults with acute cardiovascular conditions.<bold>Objectives: </bold>This study aims to evaluate rural-urban differences in procedural care and mortality for acute myocardial infarction (AMI), heart failure (HF), and ischemic stroke.<bold>Methods: </bold>This is a retrospective cross-sectional study of Medicare fee-for-service beneficiaries aged ≥65 years with acute cardiovascular conditions from 2016 to 2018. Cox proportional hazards models with random hospital intercepts were fit to examine the association of presenting to a rural (vs urban) hospital and 30- and 90-day patient-level mortality.<bold>Results: </bold>There were 2,182,903 Medicare patients hospitalized with AMI, HF, or ischemic stroke from 2016 to 2018. Patients with AMI were less likely to undergo cardiac catherization (49.7% vs 63.6%, P < 0.001), percutaneous coronary intervention (42.1% vs 45.7%, P < 0.001) or coronary artery bypass graft (9.0% vs 10.2%, P < 0.001) within 30 days at rural versus urban hospitals. Thrombolysis rates (3.1% vs 10.1%, P < 0.001) and endovascular therapy (1.8% vs 3.6%, P < 0.001) for ischemic stroke were lower at rural hospitals. After adjustment for demographics and clinical comorbidities, the 30-day mortality HR was significantly higher among patients presenting to rural hospitals for AMI (HR: 1.10, 95% CI: 1.08 to 1.12), HF (HR: 1.15; 95% CI: 1.13 to 1.16), and ischemic stroke (HR: 1.20; 95% CI: 1.18 to 1.22), with similar patterns at 90 days. These differences were most pronounced for the subset of critical access hospitals that serve remote, rural areas.<bold>Conclusions: </bold>Clinical, public health, and policy efforts are needed to improve rural-urban gaps in care and outcomes for acute cardiovascular conditions. [ABSTRACT FROM AUTHOR]
- Subjects :
- *MYOCARDIAL infarction
*RURAL-urban differences
*HEART failure
*CORONARY artery bypass
*URBAN hospitals
*MYOCARDIAL infarction treatment
*STROKE treatment
*HEART failure treatment
*STROKE-related mortality
*RURAL hospitals
*CARDIAC catheterization
*RESEARCH
*CROSS-sectional method
*RESEARCH methodology
*RETROSPECTIVE studies
*MEDICAL care
*THROMBOLYTIC therapy
*EVALUATION research
*CARDIOVASCULAR system
*COMPARATIVE studies
*RESEARCH funding
*HEALTH equity
*MEDICARE
*RURAL population
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 79
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 154563209
- Full Text :
- https://doi.org/10.1016/j.jacc.2021.10.045