Mortality and revascularization following admission for acute myocardial infarction: implication for rural veterans

Thad E Abrams; Mary Vaughan-Sarrazin; Peter J Kaboli

doi:10.1111/j.1748-0361.2010.00318.x

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Mortality and revascularization following admission for acute myocardial infarction: implication for rural veterans

Journal article

Peer reviewed

Mortality and revascularization following admission for acute myocardial infarction: implication for rural veterans

Thad E Abrams, Mary Vaughan-Sarrazin and Peter J Kaboli

The Journal of rural health, Vol.26(4), pp.310-317

2010

DOI: 10.1111/j.1748-0361.2010.00318.x

PMID: 21029165

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Abstract

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. 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. 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). 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.

Health Services Accessibility - statistics & numerical data

Confidence Intervals

Medically Underserved Area

Myocardial Infarction - mortality

Rural Population - statistics & numerical data

Prevalence

Risk Assessment

Health Status Disparities

United States

Humans

Hospitalization - statistics & numerical data

Male

Health Services Needs and Demand

Female

Myocardial Revascularization - statistics & numerical data

United States Department of Veterans Affairs

Aged

Retrospective Studies

Veterans - statistics & numerical data

Odds Ratio

Hospitals, Veterans

Patient Transfer

Details

Title: Subtitle: Mortality and revascularization following admission for acute myocardial infarction: implication for rural veterans
Creators: Thad E Abrams - VA Office of Rural Health, Midwest Rural Health Resource Center, Iowa City VA Medical Center, Iowa City, Iowa 52246, USA. Thad-Abrams@uiowa.edu
Mary Vaughan-Sarrazin
Peter J Kaboli
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.26(4), pp.310-317
Publisher: England
DOI: 10.1111/j.1748-0361.2010.00318.x
PMID: 21029165
ISSN: 0890-765X
eISSN: 1748-0361
Language: English
Date published: 2010
Academic Unit: Psychiatry; Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984063135202771

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29 Times Cited - Web of Science