Key result
Urban residence linked to ~35% lower rate of recurrent AF-related ED visits and CV hospitalizations.
Why the study?
Prior work suggested disparities in atrial fibrillation outcomes between rural and urban patients, with rural AF management mainly by primary care professionals.
Does living in a rural versus urban location affect clinical outcomes and guideline adherence in patients with atrial fibrillation managed in primary care?
Cohort (n=1,133)
Single-blind
Yes
Does living in a rural versus urban location affect clinical outcomes and guideline adherence in patients with atrial fibrillation managed in primary care?
Relative Risk: 0.65 (95% CI 0.44–0.95)
p-value: p=0.0262
Rural AF patients face higher recurrent acute care use; extends disparity observations but leaves optimal interventions hypothesis-generating.
Background In rural regions, atrial fibrillation (AF) management is performed predominately by local primary care professionals (PCPs). Prior work has suggested that a disparity in outcomes in AF occurs for those patients living in a rural, vs urban, location. Methods This post hoc analysis of the cluster randomized trial Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) compared a clinical decision support system to standard of care. Patients were classified as living in a rural (population < 10,000) or urban location. The outcomes were as follows: AF-related emergency department (ED) visits, unplanned cardiovascular (CV) hospitalizations, AF-related referrals and guideline adherence for AF treatment. Results A total of 1133 patients were enrolled from 2016 to 2018; 54.1% (n = 613) were classified as living in a rural location. No differences were present in age (mean, 72 ± 9.63 vs 72.5 ± 10.42 years) or C ongestive Heart Failure, H ypertension, A ge, D iabetes, S troke/Transient Ischemic Attack (CHADS 2 ) score (mean, 2.1 ± 1.36 vs 2.16 ± 1.34). Referral rates to general internists were higher in the rural population (13.4% vs 3.9%, P < 0.001), whereas the rate of cardiology referrals was higher in the urban population (10% vs 15%, P = 0.0098). At 12 months, no difference in the composite outcome of AF-related ED visits and CV hospitalizations was seen. Fewer recurrent AF-related ED visits and CV hospitalizations occurred in the urban group (incidence rate ratio [IRR], 0.65 [95% confidence interval (0.44, 0.95), P = 0.0262). The incidence of guideline adherence was similar between the rural (IRR, 3.7 ± 1.2) and urban (IRR, 3.6 ± 1.2; P = 0.11) groups. Conclusions AF patients living in rural locations had higher rates of recurrent AF-related ED visits and unplanned CV hospitalizations. Further research to optimize AF-related outcomes is needed to ensure equitable delivery of care to all Canadians, irrespective of geography. Clinical Trial Registration NCT01927367.
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Cox et al. (2024) conducted a cohort in Atrial Fibrillation (n=1,133). Urban location (population > 10,000) vs. Rural location (population < 10,000) was evaluated on Recurrent composite of AF-related emergency department visits and unplanned cardiovascular hospitalizations (IRR 0.65, 95% CI 0.44-0.95, p=0.0262). Patients with atrial fibrillation living in urban locations had fewer recurrent AF-related emergency department visits and cardiovascular hospitalizations compared to those in rural regions (IRR 0.65).
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