Comparison between urban and rural mortality in patients with acute myocardial infarction: a nationwide longitudinal cohort study in South Korea

Kim, Hye Sim; Kang, Dae Ryong; Kim, Inah; Lee, Kyungsuk; Jo, Hoon; Koh, Sang Baek

doi:10.1136/bmjopen-2019-035501

Cited by 14 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies based on US contexts have shown that patients with acute myocardial infarction (AMI) have higher mortality rates in rural hospitals than in urban hospitals [ 1 , 2 , 3 ]. Similar results were also found in South Korea [ 4 ]. While urban–rural differences in treatment and outcomes for patients with AMI are well studied in the United States, much larger gaps in knowledge exist in other countries, especially in low- and middle-income countries (LMIC).…”

Section: Introductionsupporting

confidence: 89%

See 1 more Smart Citation

Association of Rural Hospital Admissions with Access, Treatment, and Mortality for Patients with Acute Myocardial Infarction in Shanxi, China

Tao

Sun

2022

IJERPH

View full text Add to dashboard Cite

China recently launched healthcare reforms to reduce disparities in healthcare resources between urban and rural areas. However, few studies have determined how admission to rural hospitals has affected patient care and outcomes. This study aims to determine whether admission to a rural hospital is associated with changes in treatment and outcomes. Using a province-wide, administrative database of 62,380 patients (51,355 urban patients vs. 11,025 rural patients) with acute myocardial infarction (AMI) in Shanxi from 2015 to 2017, we identified the differential distance from the patient’s residential address to the nearest hospital and the nearest percutaneous coronary intervention (PCI)-capable hospital as instrumental variables. We estimated the risk-adjusted differences in outcomes and treatments for patients admitted to rural hospitals versus urban hospitals using a two-stage least squares instrumental variable analysis method. Based on instrumental variable analysis, admission to a rural hospital was associated with a 5.3% (95% CI, 0.012 to 0.093; p = 0.011) increase in mortality. There was a 59.8% (95% CI, −0.733 to −0.463; p-values < 0.0001) decrease in receiving PCI, an 18.8% (95% CI, −0.231 to −0.146; p-values < 0.0001) decrease in receiving fibrinolysis, and a 71.8% (95% CI, 0.586 to 0.849; p-values < 0.0001) increase in receiving medication-only treatment for patients admitted to rural hospitals. Rural hospitals in China thus offer relatively poor care for myocardial infarction. Hospital facilities and reperfusion therapies must be improved.

show abstract

Section: Introductionsupporting

confidence: 89%

“…Healthcare disparities between urban and rural areas have attracted increasing attention around the world [ 1 , 2 , 3 , 4 , 5 ]. Studies based on US contexts have shown that patients with acute myocardial infarction (AMI) have higher mortality rates in rural hospitals than in urban hospitals [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Association of Rural Hospital Admissions with Access, Treatment, and Mortality for Patients with Acute Myocardial Infarction in Shanxi, China

Tao

Sun

2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…In this study, ACS patients from the rural areas had a three-to-four -fold increased risk of in-hospital mortality compared to those from the urban areas. Studies on ACS from developed countries also show considerable disparity when mortality is stratified by urbanization [ 28 – 30 ] The higher mortality rate among ACS patients from a rural area in the current study is partially explained by prolonged pre-hospital delay in rural residents and difference in socioeconomic status which could lead to a difference in treatment and related factors. Since more rural patients die before reaching hospitals, the actual death rate is likely to be greater than reported here.…”

Section: Discussionmentioning

confidence: 74%

Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study

et al. 2021

View full text Add to dashboard Cite

Background Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia. Methods A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant. Results Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81–7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28–13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55–14.55) were independent predictors of time to in-hospital death among ACS patients. Conclusion In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.

show abstract

“…The primary exposure of this study was IHT, which was defined as a transfer to another emergency room. The IHT should be within one day of visiting an emergency room between acute care facilities to ensure that the visit was not from a long-term facility to an acute care facility [ 15 ]. The outcome of interest was the all-cause mortality assessed at 30 days and one year after the onset of AMI.…”

Section: Methodsmentioning

confidence: 99%

Did inter-hospital transfer reduce mortality in patients with acute myocardial infarction in the real world? A nationwide patient cohort study

et al. 2021

View full text Add to dashboard Cite

Introduction Inter-hospital transfer (IHT) and primary percutaneous coronary intervention (PCI) are preferred over onsite thrombolysis when provided expeditiously. On the other hand, its benefit has not been evaluated in a real-world situation. This study examined the effects of IHT on the short- and long-term mortality in patients with acute myocardial infarction (AMI) and compared the reperfusion treatments and resources between the referring and receiving hospitals. Methods Patients newly diagnosed with AMI and admitted to hospital were selected from the national health insurance database from 2004 to 2018. The 30-day and one-year mortality in the transferred and non-transferred patients were estimated and compared using stabilized inverse probability of treatment weighting to account for confounding bias. Results Of the 258,291 participants, 10,158 were transferred to one or more hospitals. IHT was more likely to occur to older or more comorbid people, patients in rural areas, and those whose insurance was medical aid. The 30-day and one-year mortality of the non-IHT group was 9.7% and 15.8%, respectively, whereas the figure was 11.4% and 20.5% in the IHT group. After balancing the baseline characteristics, the transferred patients were 1.12 (95% CI: 1.06–1.20) and 1.25 (95% CI: 1.20–1.31) times more likely to die during the subsequent 30 days and one year, respectively, than those treated solely at the presenting hospital. In ST-segment elevation myocardial infarction (STEMI), the hazard ratios of the 30-day and 1-year mortality were 1.14 (95% CI: 0.97–1.35) and 1.31 (95% CI: 1.15–1.49) in the transferred patients after balancing cardiogenic shock and cardiac arrest. On-site thrombolysis was rarely performed in the referring hospitals. Conclusion Patients transferred for the treatment of AMI experienced higher short- and long-term mortality. Therefore, onsite thrombolysis and the estimated time delay to PCI should be considered in regional hospitals to reduce mortality with the organization of STEMI treatment networks.

show abstract

Comparison between urban and rural mortality in patients with acute myocardial infarction: a nationwide longitudinal cohort study in South Korea

Cited by 14 publications

References 18 publications

Association of Rural Hospital Admissions with Access, Treatment, and Mortality for Patients with Acute Myocardial Infarction in Shanxi, China

Association of Rural Hospital Admissions with Access, Treatment, and Mortality for Patients with Acute Myocardial Infarction in Shanxi, China

Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study

Did inter-hospital transfer reduce mortality in patients with acute myocardial infarction in the real world? A nationwide patient cohort study

Contact Info

Product

Resources

About