Geographic Variation in Treatment and Outcomes Among Patients With AMI: Investigating Urban‐Rural Differences Among Hospitalized Patients

Bechtold, Daniel; Salvatierra, Gail G.; Bulley, Emily; Cypro, Alex; Daratha, Kenn B.

doi:10.1111/jrh.12165

Cited by 15 publications

(7 citation statements)

References 26 publications

(35 reference statements)

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“…However certain rural territories (clusters 3 and 4) with longer access times to the closest angiography facility had lower in-hospital prevalence and mortality for AMI, suggesting that longer distances to facilities are not systematically related to such health indicators. These results are consistent with a previous American study which concluded that in-hospital mortality for AMI was not related to a rural place of residence [ 40 ]. However, rural residents had a higher risk of transfer and 30-day readmission.…”

Section: Discussionsupporting

confidence: 93%

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

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Roussot

Cottenet

et al. 2020

American Journal of Preventive Cardiology

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Objective To describe the spatial distribution of acute myocardial infarction (AMI) mortality in France in association with the socio-economic characteristics of the patient’s place of residence. Methods In this population-based study, we included patients hospitalized for AMI identified according to ICD-10 codes, using data from the national health insurance database from January 1, 2013 to December 31, 2014. In- and out-of-hospital deaths were identified over a period of 1 year following the first hospital stay for AMI. An exploratory analysis was performed to classify area profiles. The spatial analysis of AMI mortality was performed using a principal component analysis followed by an ascending hierarchical classification taking into account socio-economic data, access-time by road to coronary angiography, standardized in-hospital prevalence, and 1 year mortality. Results Over the 2 years, 115,418 patients were hospitalized with a diagnosis of AMI. Patients were a mean of 68 ± 15 years and most were men (68.5%). The overall mortality rate was 12.2% after 1 year. More than half of patients (65.5%) underwent an early revascularization procedure. The map of standardized 1 year mortality showed a geographic area of high mortality extending diagonally from north-east to south-west France. We identified 6 different area profiles with standardized mortality varying from 15.9 to 54.4 per 100,000 inhabitants. The spatial distribution of higher mortality was associated with lower socioeconomic levels. These findings were not associated with a lower access to coronary angiography. Conclusion There are considerable geographical differences in the prevalence of AMI and 1 year mortality. The spatial distribution of lower healthcare indicators follows the distribution of social inequalities. This study highlights the importance of focusing national policies on universally accessible prevention programs such as the promotion cardiac rehabilitation and healthy lifestyles.

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Section: Discussionsupporting

confidence: 93%

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Piccard

Roussot

Cottenet

et al. 2020

American Journal of Preventive Cardiology

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“…Multiple studies have detailed how rural patients experience delays or limitations in accessing health care (4, 35), and prior studies have examined the issue of patient choice in rural patients’ receipt of care in rural hospitals. (15, 21–23, 36–39) Much of the data describing rural hospital bypass focuses on elective and scheduled health care (20, 24, 40), rather than unscheduled emergent care.…”

Section: Discussionmentioning

confidence: 99%

Rural Patients With Severe Sepsis or Septic Shock Who Bypass Rural Hospitals Have Increased Mortality: An Instrumental Variables Approach*

Mohr

Harland

Shane

et al. 2017

Critical Care Medicine

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Objective To identify factors associated with rural sepsis patients’ bypassing rural emergency departments (EDs) to seek emergency care in larger hospitals, and to measure the association between rural hospital bypass and sepsis survival. Design, Setting, and Patients Cohort study of adults treated in EDs of a rural Midwestern state with severe sepsis or septic shock between 2005 and 2014, using administrative claims data. Patients residing ≥ 20 miles from a top-decile sepsis volume hospital and < 20 miles from a local hospital were included. Interventions Patients bypassing local rural hospitals to seek care in larger hospitals. Measurements and Main Results A total of 13,461 patients were included, and only 5.4% (n = 731) bypassed a rural hospital for their ED care. Patients who initially chose a top-decile sepsis volume hospital were younger (64.7 vs. 72.7 y, p<0.001) and were more likely to have commercial insurance (19.6% vs. 10.6%, p<0.001) than those who were seen initially at a local rural hospital. They were also more likely to have significant medical comorbidities, such as liver failure (9.9% vs 4.2%, p<0.001), metastatic cancer (5.9% vs 3.2%, p<0.001), and diabetes with complications (25.2% vs. 21.6%, p=0.024). Using an instrumental variables approach, rural hospital bypass was associated with a 5.6% increase (95%CI 2.2 – 8.9%) in mortality. Conclusions Most rural patients with sepsis seek care in local EDs, but demographic and disease-oriented factors are associated with rural hospital bypass. Rural hospital bypass is independently associated with increased mortality.

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“…21 Several publications appeared following these classical studies, whose authors called attention to regional differences regarding the incidence and treatment of myocardial infarction. 13,[22][23][24][25][26][27][28][29] Furthermore, upon examining the same problem, several articles underlined the role of the social environment of the population. [30][31][32][33] In a meta-analysis of several studies, Manrique-Garcia et al 14 found that the incidence of myocardial infarction was influenced both by the social and economic status of the population as well as their educational background, that is the incidence of myocardial infarction was higher in underprivileged people.…”

Section: Discussionmentioning

confidence: 99%

Incidence, pre‐hospital delay and prognosis of acute myocardial infarction in big regions of Hungary: Population data from the Hungarian myocardial infarction registry

Jánosi¹,

Pach²,

Erdős³

et al. 2021

Int J Clin Pract

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One of the earliest population-based surveys regarding the incidence and treatment of myocardial infarction was initiated and coordinated by the World Health Organisation ~30 years ago. 1 Over the past two decades, many European and Far Eastern countries have launched registries covering the entire population, 2-5 and several comparative international studies have been performed. [6][7][8][9] Because of the varying methodologies of these registries, the comparative evaluation of data has only been possible with certain

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Geographic Variation in Treatment and Outcomes Among Patients With AMI: Investigating Urban‐Rural Differences Among Hospitalized Patients

Cited by 15 publications

References 26 publications

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Rural Patients With Severe Sepsis or Septic Shock Who Bypass Rural Hospitals Have Increased Mortality: An Instrumental Variables Approach*

Incidence, pre‐hospital delay and prognosis of acute myocardial infarction in big regions of Hungary: Population data from the Hungarian myocardial infarction registry

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