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
3-9
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
January 2023
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.
(2023)
Invasive management and in-hospital outcomes of myocardial infarction patients in rural versus urban hospitals in the United States.
Cardiovascular Revascularization Medicine, 46, .
(doi:10.1016/j.carrev.2022.08.023).
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.
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Accepted/In Press date: 18 August 2022
Published date: January 2023
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Funding Information:
None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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© 2022 The Authors
Keywords:
Country, Disparity, MI, Rural
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Local EPrints ID: 469671
URI: http://eprints.soton.ac.uk/id/eprint/469671
ISSN: 1553-8389
PURE UUID: 770567c9-2419-4a79-b09a-16052b16c822
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Date deposited: 21 Sep 2022 17:08
Last modified: 17 Mar 2024 07:28
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Author:
Hussein Bashar
Author:
Andrija Matetic
Author:
Mamas A. Mamas
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