The University of Southampton
University of Southampton Institutional Repository

Invasive management and in-hospital outcomes of myocardial infarction patients in rural versus urban hospitals in the United States

Invasive management and in-hospital outcomes of myocardial infarction patients in rural versus urban hospitals in the United States
Invasive management and in-hospital outcomes of myocardial infarction patients in rural versus urban hospitals in the United States
Objectives: The variation in the management and outcome of acute myocardial infarction (AMI) between rural and urban settings has been previously recognized, but there has previously been no nationwide data reported that is inclusive of the whole adult population.

Methods: All discharge records between 2004 and 2018 with AMI diagnosis were extracted from the National Inpatient Sample (NIS) database and stratified by hospital location. The primary outcome was in-hospital mortality, and secondary outcomes included (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) major bleeding, (c) acute ischemic stroke, the utilization of invasive management in the form of (d) coronary angiography (CA), and (e) percutaneous coronary intervention (PCI). The adjusted odds ratios (aOR) and 95 % confidence interval (95 % CI) were determined using multivariable logistic regression.

Results: 9,728,878 records with AMI were identified, of which 1,011,637 (10.4 %) discharges were from rural hospitals. Rural patients were older (median of 71 years vs. 67 years, p < 0.001) and had lower prevalence of the highest risk presentations of AMI than their urban counterparts. After multivariable adjustment, patients from rural hospitals had increased aOR of all-cause mortality (aOR 1.15 95 % CI 1.13-1.16) and MACCE (aOR 1.04 95 % CI 1.04-1.05), as well as the decreased aOR of coronary angiography (aOR 0.29, 95 % CI 0.29-0.29, p < 0.001) and PCI (aOR 0.40, 95 % CI 0.39-0.40, p < 0.001), compared to their urban counterparts.

Conclusion: Between 2004 and 2018, the risk of in-hospital mortality and MACCE in AMI patients was significantly higher in rural hospitals, with considerably lower utilization of invasive angiography and revascularization.
Country, Disparity, MI, Rural
1553-8389
Bashar, Hussein
b7a20bc4-5bb1-468e-bcb4-90d0984d3c71
Matetic, Andrija
037606fe-7442-48a9-a4a2-a4c4789b529b
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A.
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Bashar, Hussein
b7a20bc4-5bb1-468e-bcb4-90d0984d3c71
Matetic, Andrija
037606fe-7442-48a9-a4a2-a4c4789b529b
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A.
41515b72-75ff-4922-bb9f-8f9c63f9f5af

Bashar, Hussein, Matetic, Andrija, Curzen, Nicholas and Mamas, Mamas A. (2022) Invasive management and in-hospital outcomes of myocardial infarction patients in rural versus urban hospitals in the United States. Cardiovascular Revascularization Medicine. (doi:10.1016/j.carrev.2022.08.023). (In Press)

Record type: Article

Abstract

Objectives: The variation in the management and outcome of acute myocardial infarction (AMI) between rural and urban settings has been previously recognized, but there has previously been no nationwide data reported that is inclusive of the whole adult population.

Methods: All discharge records between 2004 and 2018 with AMI diagnosis were extracted from the National Inpatient Sample (NIS) database and stratified by hospital location. The primary outcome was in-hospital mortality, and secondary outcomes included (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) major bleeding, (c) acute ischemic stroke, the utilization of invasive management in the form of (d) coronary angiography (CA), and (e) percutaneous coronary intervention (PCI). The adjusted odds ratios (aOR) and 95 % confidence interval (95 % CI) were determined using multivariable logistic regression.

Results: 9,728,878 records with AMI were identified, of which 1,011,637 (10.4 %) discharges were from rural hospitals. Rural patients were older (median of 71 years vs. 67 years, p < 0.001) and had lower prevalence of the highest risk presentations of AMI than their urban counterparts. After multivariable adjustment, patients from rural hospitals had increased aOR of all-cause mortality (aOR 1.15 95 % CI 1.13-1.16) and MACCE (aOR 1.04 95 % CI 1.04-1.05), as well as the decreased aOR of coronary angiography (aOR 0.29, 95 % CI 0.29-0.29, p < 0.001) and PCI (aOR 0.40, 95 % CI 0.39-0.40, p < 0.001), compared to their urban counterparts.

Conclusion: Between 2004 and 2018, the risk of in-hospital mortality and MACCE in AMI patients was significantly higher in rural hospitals, with considerably lower utilization of invasive angiography and revascularization.

Text
Rural vs Urban Manuscript 22 8 22 - Accepted Manuscript
Restricted to Repository staff only until 18 August 2023.
Request a copy
Text
1-s2.0-S1553838922007278-main - Proof
Restricted to Repository staff only
Request a copy

More information

Accepted/In Press date: 18 August 2022
Keywords: Country, Disparity, MI, Rural

Identifiers

Local EPrints ID: 469671
URI: http://eprints.soton.ac.uk/id/eprint/469671
ISSN: 1553-8389
PURE UUID: 770567c9-2419-4a79-b09a-16052b16c822
ORCID for Nicholas Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 21 Sep 2022 17:08
Last modified: 19 Nov 2022 02:37

Export record

Altmetrics

Contributors

Author: Hussein Bashar
Author: Andrija Matetic
Author: Nicholas Curzen ORCID iD
Author: Mamas A. Mamas

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×