An Examination of Geographic Proximity to Outpatient Cardiac Rehabilitation in Rural Versus Urban Tennessee Counties

BACKGROUND: Although outpatient cardiac rehabilitation (OCR) is associated with improved outcomes post myocardial infarction (MI), authors of limited US studies report OCR travel distance/time estimates with fewer providing rural-urban comparisons. OBJECTIVE: We examined travel distance/time to the closest OCR facility for each Tennessee county. METHODS: We identified n = 61 Tennessee OCR facilities through a Tennessee Association of Cardiovascular and Pulmonary Rehabilitation list and a data scraping process using cardiac rehabilitation-related keywords. County-level mean travel distance/time to the closest OCR facility was determined using geospatial analysis. We conducted Kruskal-Wallis tests to examine whether mean travel distance/time varied by rural/urban county status and also by MI hospitalization rate status (low, 0 to <33.33 percentile; medium, 33.33 to <66.66 percentile; high, ≥66.66 percentile). RESULTS: Of Tennessee's 95 counties, 62.3% of facilities were in its 42 urban counties. Mean (SD) county-level travel distance to the closest OCR was 16.6 (10.0) miles, and mean (SD) county-level travel time was 27.9 (13.6) minutes. Travel distance/time did not significantly differ by rural/urban county status (rural: 15.4 miles, 28.9 minutes; urban: 12.9 miles, 23.2 minutes) or by MI hospitalization rate status (low: 10.4 miles, 19.6 minutes; medium: 14.5 miles, 24.1 minutes; high: 18.8 miles, 30.7 minutes). CONCLUSIONS: Our findings indicate that overall mean travel distance was around half an hour, but lack of OCR facilities in rural Tennessee counties did not correspond with significantly greater travel distance/time to OCR in rural versus urban counties. Additional efforts are warranted to help patients post-MI with actual or perceived high travel burden navigate personal and structural factors precluding OCR receipt.