Geographic Variation in Treatment and Outcomes Among Patients With AMI
Investigating Urban‐Rural Differences Among Hospitalized Patients
Bibliographic Data
| ID | 19432220 |
|---|---|
| Authors | Daniel Bechtold (0000-0003-1017-1842, School of Medicine University of Washington Seattle Washington, corresponding author), Gail G Salvatierra (Seattle University), Emily Bulley (School of Medicine University of Washington Seattle Washington), A Cypro (0000-0002-4857-3217, University of Washington), Kenn B Daratha (0000-0002-9194-4140, Department of Medical Education and Biomedical Informatics University of Washington Spokane and Seattle Washington) |
| Year | 2017 |
| Volume | 33 |
| Issue | 2 |
| Pages | 158-166 |
| Publication date | 2017-04-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | The Journal of Rural Health (JOURNAL) |
| Journal identifiers | ISSN: 0890-765X • E-ISSN: 1748-0361 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/jrh.12165 |
| PMID | 26633577 |
| OpenAlex | W2182472797 |
| Language | EN |
| References cited | 26 |
BACKGROUND: The value of early invasive revascularization for patients suffering acute myocardial infarction (AMI) is well known. However, access to revascularization services varies geographically and demographically. Previous studies have not examined the influence of rural residence on revascularization rates and outcomes among patients hospitalized with AMI. METHODS: Our retrospective cohort study included patients hospitalized in Washington State with a primary diagnosis of AMI from 2009 to 2012. Urban or rural residence was determined using rural-urban commuting area (RUCA) codes. Multivariable models were used to evaluate geographic variation in rates of invasive versus medical management, in-hospital mortality, rehospitalization, and subsequent revascularization procedures. RESULTS: Our study included 25,156 urban dwellers and 2,770 rural residents. Adjusted models found rural patients to be at increased odds of undergoing invasive revascularization during the initial episode of AMI care (OR = 1.11; 95% CI: 1.01-1.21; P = .02) compared to urban dwelling patients. Rural patients were more likely to be transferred for care (OR = 4.28; 95% CI: 3.93-4.66; P < .001) and more likely to undergo coronary artery bypass grafting (CABG) (OR = 1.55; 95% CI: 1.35-1.78; P < .001) compared to the urban cohort. We found no significant geographic cohort differences in in-hospital mortality or subsequent revascularization rates. CONCLUSION: Our findings suggest that despite limited access to cardiac care facilities, rural patients are accessing revascularization services. However, rural residents are more likely to undergo CABG during their index admission. High transfer rates suggest that rural regions rely on effective transfer networks to access invasive cardiac services
Artery · Bypass grafting · Cohort · Logistic regression · Mortality rate · Myocardial infarction · Odds · Odds ratio · Residence · Retrospective cohort study · Revascularization · Rural area · Acute Myocardial Infarction Research · Demography · Global Health Workforce Issues · Medicine · Trauma and Emergency Care Studies · Emergency Medicine · Internal Medicine
Heart Disease and Stroke Statistics—2014 Update
Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals
Mortality and Revascularization Following Admission for Acute Myocardial Infarction
Metropolitan, Urban, and Rural Commuting Areas
Comorbidity Measures for Use with Administrative Data
| Citation velocity | historical |
|---|---|
| Highly cited | No |