Among Medicare beneficiaries with HFrEF, living in a rural area was associated with higher 30-day mortality compared to urban areas (6.3% vs 5.7%; fully adjusted OR 1.140, 95% CI 1.103-1.178).
Cohort (n=389,528)
Yes
Does rural residence increase mortality and readmissions in Medicare beneficiaries with HFrEF compared to urban residence?
Living in a rural area is associated with an increased risk of 30-day mortality and return ER visits following HF hospitalization among Medicare beneficiaries with HFrEF, which is only partially explained by social determinants of health.
Odds Ratio: 1.14 (95% CI 1.103–1.178)
Absolute Event Rate: 6.3% vs 5.7%
p-value: p=<.001
PURPOSE: There is now a 20% disparity in all-cause, excess deaths between urban and rural areas, much of which is driven by disparities in cardiovascular death. We sought to explain the sources of these disparities for Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF). METHODS: Using a sample of Medicare Parts A, B, and D, we created a cohort of 389,528 fee-for-service beneficiaries with at least 1 heart failure hospitalization from 2008 to 2017. The primary outcome was 30-day mortality after discharge; 1-year mortality, readmissions, and return emergency room (ER) admissions were secondary outcomes. We used hierarchical, logistic regression modeling to determine the contribution of comorbidities, guideline-directed medical therapy (GDMT), and social determinants of health (SDOH) to outcomes. RESULTS: Thirty-day mortality rates after hospital discharge were 6.3% in rural areas compared to 5.7% in urban regions (P < .001); after adjusting for patient health and GDMT receipt, the 30-day mortality odds ratio for rural residence was 1.201 (95% CI 1.164-1.239). Adding the SDOH measure reduced the odds ratio somewhat (1.140, 95% CI 1.103-1.178) but a gap remained. Readmission rates in rural areas were consistently lower for all model specifications, while ER admissions were consistently higher. CONCLUSIONS: Among patients with HFrEF, living in a rural area is associated with an increased risk of death and return ER visits within 30 days of discharge from HF hospitalization. Differences in SDOH appear to partially explain mortality differences but the remaining gap may be the consequence of rural-urban differences in HF treatment.
Zeitler et al. (Sun,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=389,528). Rural residence vs. Urban residence was evaluated on 30-day mortality after discharge (OR 1.140, 95% CI 1.103-1.178, p=<.001). Among Medicare beneficiaries with HFrEF, living in a rural area was associated with higher 30-day mortality compared to urban areas (6.3% vs 5.7%; fully adjusted OR 1.140, 95% CI 1.103-1.178).