Rural residence tied to increased mortality in HF
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Living in a rural area was associated with an elevated mortality rate in patients with HF, according to study findings published in the Journal of the American Heart Association.
“Rural residents in the United States experience excess mortality compared with their urban counterparts. ... While the exact mechanism for these associations is not entirely clear, patients in rural areas may have more challenges accessing care because of several barriers,” Sheila M. Manemann, MPH, health services analyst in the Cardiovascular Disease and Outcomes Research Program at Mayo Clinic, and colleagues wrote. “While these results are a cause for substantial concern, data remain limited and, specifically, the impact of rurality on HF outcomes is understudied.”
The researchers analyzed 6,003 patients (mean age, 74 years; 48% women; 43% with rural residence) with HF from six southeastern Minnesota counties to examine the association between urban residence vs. rural residence with death, hospitalization and ED visits.
After a mean follow-up of 2.8 years, 20,506 ED visits, 11,311 hospitalizations and 2,440 deaths occurred. Compared with urban residents, rural residents had increased risk for all-cause death (0.13 deaths per patient-year vs. 0.17 deaths per patient-year; HR = 1.18; 95% CI, 1.09-1.29) and decreased risk for ED visits (1.31 per patient-year vs. 1.16 per patient-year; HR = 0.89; 95% CI, 0.82-0.97) and hospitalizations (0.76 per patient-year vs. 0.58 per patient-year; HR = 0.78; 95% CI, 0.73-0.84).
“In a southeastern Minnesota community, almost half of the patients with HF live in a rural area, which is associated with significant disparities including an increased risk of death. ... Rurality was also associated with fewer ED visits and hospitalizations, possibly reflecting difficulties in accessing care,” Manemann and colleagues wrote. “Our study highlights important rural-urban disparities among patients with HF, and further studies are needed to identify and address the mechanisms through which rural residence influences these poor outcomes.”
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