Mortality and hospitalization of heart failure patients between rural and urban areas:a systematic review and meta-analysis of 18 million patients

Objectives: Challenges in social determinants of health, fewer hospitals, further referral sites, and specialist scarcity in rural areas may hinder medical care, thus resulting in poorer outcomes for heart failure patients. This meta-analysis aims to assess the differences in mortality and other clinical outcomes of HF patients between rural and urban areas. Methods: A systematic search for eligible studies was conducted in PubMed, Embase, Medline, Science Direct, and Scopus databases. Primary outcomes were in-hospital, 30-day, and long-term mortality. Secondary outcomes were physician revisit and rehospitalization, ER readmission, and length of stay. Twenty studies with 18,893,519 participants were included. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) from each study were analyzed using Review Manager 5.4. Results: HF patients in rural areas showed more significant long-term mortality (aOR = 1.09; 95% CI: 1.07–1.10; I2 = 0%; p < 0.001) and 30-day mortality (OR =1.14; 95% CI: 1.12–1.16; I2 = 33%; p < 0.001). Hospitalizations in rural areas resulted in shorter length of stay (MD = −0.95; 95% CI: −1.17-(−0.74); I2 = 32%; p < 0.001). Rural patients had more frequent 1-year ER readmission (OR =1.34; 95% CI: 1.03–1.76; I2 = 91%; p = 0.03). Conclusion: In conclusion, HF patients in rural areas demonstrated poorer outcomes, which may be related to shorter lengths of stay and suboptimal healthcare utilization.