Key result
Rural veterans with AMI had similar 30-day mortality to urban veterans, but lower revascularization rates when classified by the RUCA system.
Why the study?
Does rural residence affect mortality and revascularization rates in veterans admitted for acute myocardial infarction?
Cohort (n=15,870)
Yes
Does rural residence affect mortality and revascularization rates in veterans admitted for acute myocardial infarction?
Rural veterans admitted for AMI have similar 30-day mortality but potentially lower rates of revascularization compared to urban veterans, depending on the rural classification system used.
Answers are grounded in this paper and cite their sources.
Similar short-term mortality despite lower revascularization rates is reassuring for rural veterans; leaves open questions on classification systems and long-term equity.
INTRODUCTION: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. METHODS: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables. RESULTS: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93). CONCLUSION: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans.
No takes yet. Share an insight, caveat, or question.
Abrams et al. (2010) conducted a cohort in Acute myocardial infarction (n=15,870). Rural residence vs. Urban residence was evaluated on Coronary revascularization (HR 0.89, 95% CI 0.83-0.95). Rural veterans with AMI had similar 30-day mortality to urban veterans, but lower revascularization rates when classified by the RUCA system.
Synapse has enriched 10 related papers. Consider them for comparative context: