What question did this study set out to answer?

To assess differences in care quality and 30-day mortality for patients presenting with acute myocardial infarction across rural hospitals of varying remoteness compared with urban hospitals.

March 1, 2004The Journal of Rural Health

Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=135759). Intervention: Rural hospital admission vs. Urban hospital admission. Primary outcome: 30-day post-AMI death rates from all causes (OR 1.32, 95% CI 1.23 to 1.41).

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Key result

Medicare patients with AMI in rural hospitals had higher adjusted 30-day all-cause mortality than those in urban hospitals, peaking in remote small rural hospitals (OR 1.32; 95% CI 1.23-1.41).

Why the study?

Does admission to rural hospitals compared to urban hospitals affect the quality of care and 30-day mortality in Medicare patients with acute myocardial infarction?

Population

135,759 Medicare beneficiaries ages 65 and older with a confirmed acute myocardial infarction directly…

Comparison

Admission to rural hospitals. vs Admission to urban hospitals.

Design

Cohort

Follow-up

30-day

Authors

LBLaura‐Mae BaldwinUniversity of Washington RMRichard F. MacLehosePreventive Cardiology LHL. Gary HartUniversity of North Dakota

Discussion

Member takes

Implication

Supports rural AMI quality initiatives; leaves open whether targeted interventions narrow mortality gaps.

Key Points

To assess differences in care quality and 30-day mortality for patients presenting with acute myocardial infarction across rural hospitals of varying remoteness compared with urban hospitals.
Cohort study analyzing data from the Cooperative Cardiovascular Project on 135,759 direct Medicare admissions (ages ≥65) with confirmed acute myocardial infarction across 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) between February 1994 and July 1995.
Evaluated acute in-hospital therapies (aspirin, reperfusion, heparin, intravenous nitroglycerin), discharge therapies (beta-blockers, aspirin, ACE inhibitors, calcium channel blocker avoidance), and adjusted 30-day all-cause mortality.
Rural hospital patients were less likely than urban hospital patients to receive acute aspirin, intravenous nitroglycerin, heparin, and reperfusion (thrombolytics or percutaneous transluminal coronary angioplasty), whereas discharge ACE inhibitor use was higher in rural hospitals.
Adjusted 30-day post-infarction all-cause mortality was higher in rural settings compared to urban hospitals, scaling with degree of remoteness: large rural odds ratio 1.14 (95% CI, 1.10–1.18), small rural odds ratio 1.24 (95% CI, 1.20–1.29), and remote small rural odds ratio 1.32 (95% CI, 1.23–1.41).

Study Design

Type

Cohort (n=135,759)

Multicenter

Yes

Structured PICO

Does admission to rural hospitals compared to urban hospitals affect the quality of care and 30-day mortality in Medicare patients with acute myocardial infarction?

Population

135,759 Medicare beneficiaries ages 65 and older with a confirmed acute myocardial infarction (AMI) directly admitted to 4,085 acute care hospitals between February 1994 and July 1995.

Intervention

Admission to rural hospitals (remote small rural, small rural, large rural).

Comparator

Admission to urban hospitals.

Outcome

Use of recommended treatments (aspirin, reperfusion, heparin, intravenous nitroglycerin during hospitalization; beta-blockers, aspirin, and ACE inhibitors at discharge; avoidance of calcium channel blockers at discharge) and 30-day mortality.hard clinical

Main Result

Effect estimate: OR 1.32 (95% CI 1.23 to 1.41)

Medicare patients with acute myocardial infarction admitted to rural hospitals receive fewer recommended treatments and have higher 30-day mortality compared to those admitted to urban hospitals.

Cite This Study

Baldwin et al. (2004) conducted a cohort in Acute myocardial infarction (n=135,759). Rural hospital admission vs. Urban hospital admission was evaluated on 30-day post-AMI death rates from all causes (OR 1.32, 95% CI 1.23 to 1.41). Medicare patients with AMI in rural hospitals had higher adjusted 30-day all-cause mortality than those in urban hospitals, peaking in remote small rural hospitals (OR 1.32; 95% CI 1.23-1.41).

synapsesocial.com/papers/6a0fe9715725bbd5cc603bda https://doi.org/10.1111/j.1748-0361.2004.tb00015.x

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Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider