What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart failure (n=18893519). Intervention: Rural residence vs. Urban residence. Primary outcome: In-hospital, 30-day, and long-term mortality (p=0.03).

What question did this study set out to answer?

This meta-analysis evaluates mortality and clinical outcomes differences for heart failure patients in rural versus urban areas.

May 16, 2026

Mortality and hospitalization of heart failure patients between rural and urban areas: a systematic review and meta-analysis of 18 million patients

Key Result

Heart failure patients in rural areas demonstrated poorer outcomes compared to those in urban areas (P=0.03), potentially related to shorter lengths of stay and suboptimal healthcare utilization.

Key Points

This meta-analysis evaluates mortality and clinical outcomes differences for heart failure patients in rural versus urban areas.
Conducted a systematic search in multiple databases for eligible studies.
Included twenty studies with 18,893,519 participants.
Analyzed outcomes using odds ratios (ORs) or adjusted ORs (aORs) and mean differences (MDs).
HF patients in rural areas had significantly higher mortality rates (OR not specified).
Shorter lengths of stay were observed in rural HF patients, impacting healthcare utilization.
Poorest outcomes may relate to social determinants of health and fewer healthcare resources in rural areas.

Study Design

Type

Meta-Analysis (n=18,893,519)

Structured PICO

Does rural residence compared to urban residence worsen mortality and clinical outcomes in heart failure patients?

Population

18,893,519 heart failure patients pooled from 20 studies

Intervention

Rural residence

Comparator

Urban residence

Outcome

In-hospital, 30-day, and long-term mortalityhard clinical

Heart failure patients residing in rural areas experience poorer clinical outcomes compared to those in urban areas, highlighting disparities in healthcare access and utilization.

Main Result

p-value: p=0.03

Abstract

OBJECTIVES: Challenges in social determinants of health, fewer hospitals, further referral sites, and specialist scarcity in rural areas may hinder medical care, thus resulting in poorer outcomes for heart failure patients. This meta-analysis aims to assess the differences in mortality and other clinical outcomes of HF patients between rural and urban areas. METHODS: A systematic search for eligible studies was conducted in PubMed, Embase, Medline, Science Direct, and Scopus databases. Primary outcomes were in-hospital, 30-day, and long-term mortality. Secondary outcomes were physician revisit and rehospitalization, ER readmission, and length of stay. Twenty studies with 18,893,519 participants were included. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) from each study were analyzed using Review Manager 5.4. RESULTS: = 0.03). CONCLUSION: In conclusion, HF patients in rural areas demonstrated poorer outcomes, which may be related to shorter lengths of stay and suboptimal healthcare utilization.

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