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December 1, 2013ViewOpen Access

Patients in urban areas had significantly lower 30-day mortality (OR: 0.709, 95% CI: 0.626-0.802) and overall hazard of AMI death (HR: 0.86, 95% CI: 0.806-0.931) compared to patients in rural areas.

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Why the study?

Does urban location compared to rural location improve 30-day and overall survival in patients hospitalized for acute myocardial infarction?

Population

Patients hospitalized for acute myocardial infarction (AMI) in Nebraska between January 2005 and December 2009

Comparison

Urban location vs Rural location

Design

Cohort

Follow-up

Through October 2011

Authors

SBSoumitra Sudip BhuyanYWYang WangSOSamuel T. Opoku

Discussion

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Member takes

Overview

Rural AMI patients face higher mortality; extends disparity observations but leaves open causal mechanisms and interventions.

Key Points

  • To examine rural-urban disparities in 30-day and long-term mortality following acute myocardial infarction hospitalization and identify associated clinical risk factors.
  • Conducted a retrospective cohort study linking hospital discharge data from January 2005 to December 2009 with state death certificate records through October 2011 in Nebraska.
  • Used multivariate logistic regression to evaluate 30-day mortality and Cox proportional hazards modeling to evaluate out-of-hospital and overall survival, controlling for demographics, comorbidities, and cardiac rehabilitation.
  • Urban patients had lower 30-day mortality compared to rural patients (odds ratio: 0.709, 95% CI: 0.626–0.802) after adjusting for age, comorbidities, and rehabilitation.
  • Urban residence was associated with reduced hazard of overall death (hazard ratio: 0.86, 95% CI: 0.806–0.931), whereas prior heart failure, atrial fibrillation, and chronic kidney disease significantly worsened survival.
  • Attendance of at least one cardiac rehabilitation session was strongly associated with decreased 30-day and overall mortality (p < 0.0001).

Structured PICO

Does urban location compared to rural location improve 30-day and overall survival in patients hospitalized for acute myocardial infarction?

P
Population
Patients hospitalized for acute myocardial infarction (AMI) in Nebraska between January 2005 and December 2009
I
Intervention
Urban location
C
Comparator
Rural location
O
Outcome
30-day mortality and overall survivalhard clinical

Urban AMI patients have significantly lower 30-day and overall mortality compared to rural patients, highlighting geographic disparities in care and outcomes.

Cite This Study

Bhuyan et al. (2013) studied this question.

synapsesocial.com/papers/6a1bdb9727b545b111a91ecehttps://doi.org/10.1016/j.jcdr.2014.01.006
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Invasive Management and In-Hospital Outcomes of Myocardial Infarction Patients in Rural Versus Urban Hospitals in the United States2022 · 8 citations
  2. 2Geographic Variation in Treatment and Outcomes Among Patients With AMI: Investigating Urban‐Rural Differences Among Hospitalized Patients2015 · 20 citations
  3. 3Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals2004 · 151 citations
  4. 4Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans2010 · 37 citations
  5. 5Characteristics, Process Metrics, and Outcomes Among Patients With ST-Elevation Myocardial Infarction in Rural vs Urban Areas in the US2022 · 33 citations