Rural-urban disparities in baseline health factors and procedure outcomes.

BACKGROUND: Rural populations have known challenges to both emergency and ambulatory care access resulting in delayed presentation and poorer outcomes for stroke and heart attack patients. Conditions such as diabetes and hypertension are known to be more common among rural populations. However, it is unclear whether there are any differences in underlying clinical factors and outcomes among patients presenting to a tertiary care center for advanced cardiac procedures from rural versus urban areas. OBJECTIVE: We sought to assess rural-urban disparities in baseline health factors and outcomes in patients presenting for cardiac procedures. DESIGN AND PARTICIPANTS: We performed a retrospective study of 1775 patients who presented directly or were transferred to University of Tennessee Medical Center between July 2018 to October 2019 from rural/Appalachian or urban areas for heart catheterization and stent procedures. We compared these rural to urban cardiac patients on baseline factors (diabetes, hypertension, stroke, vascular disease, prior bypass surgery and heart failure) and outcomes (number of patients receiving stents, procedure times, bleeding complications, and mortality). KEY RESULTS: Rural residents had more vascular disease, prior bypass surgery and worse outcomes requiring significantly more stents (8.55% vs 34.36%, P=<0.001; OR 5.51 CI 4.13 to 7.34), longer procedure times (14.86 ± 11.69 mins vs 12.59 ± 14.87 mins, P=0.04), and had more bleeding complications (1.6% vs 0.4%, p= < 0.001), and higher mortality (2.2% vs 0.7%, p= 0.02). CONCLUSIONS: Our study identified rural-urban differences in baseline factors and procedural outcomes in patients presenting to a tertiary care center for cardiac procedures. Providers should anticipate that health disparities may be associated with more intervention and worse outcomes in their rural patients. Being aware of such differences may also help policy makers in directing health care funding to lower gaps in health care and access ultimately leading to better health outcomes.

Gender-Based Disparities in Rural Versus Urban Patients Undergoing Cardiac Procedures.

Introduction Rural populations have higher rates of diabetes and hypertension (HTN) with disparities in outcomes among patients presenting to the emergency room with heart attack and stroke. However, it is unclear whether there are any sex differences among patients presenting for cardiac procedures from rural versus urban areas. Our study aimed to investigate gender-based differences in baseline characteristics and procedural outcomes among rural and urban residents presenting for cardiac catheterization and percutaneous interventional procedures. Methods We assessed baseline conditions and outcomes in 1775 patients who underwent cardiac catheterization and or Percutaneous Coronary Intervention at the University of Tennessee Medical Center between July 2018 to October 2019 from rural as well as urban areas. Baseline conditions assessed were diabetes, HTN, stroke, peripheral vascular disease, heart failure, and prior bypass surgery. Outcomes assessed were vascular/bleeding complications, duration of the procedure, and mortality. Results There were significant gender-based inter-group differences in outcomes between rural versus urban residents. In general, both rural and urban males had significantly longer procedure times and higher mortality than rural or urban females (P=0.01). Among females, rural women had longer procedure times than urban women. Bleeding complications were greater among rural residents than urban residents (p≤0.001), with rural females having the highest bleeding complication rate. Mortality was also higher among rural females compared to their urban counterparts (p=0.01). Significant gender-based inter-group differences were noted between rural versus urban residents. While the incidence of stroke was higher among rural and urban females compared to males, the peripheral vascular disease was more common among males. The history of coronary artery bypass graft (CABG) was more commonly seen among rural males than females. Rural and urban males had significantly longer procedure times than females, particularly urban females (P=0.01). Among women, rural females had longer procedure times, higher vascular/bleeding complications, and greater mortality than urban females. Mortality was higher among rural men and women compared to urban men or women (p=0.01). Rural women had the highest bleeding/vascular complications. Conclusions We found significant gender-based differences between rural versus urban patients. While rural females had a higher incidence of stroke, peripheral vascular disease and a history of CABG were more commonly seen among rural males. Overall, rural males had higher mortality than females (P=0.01). Among women, rural females had longer procedure times, higher bleeding complications, and greater mortality than urban females. Being aware of such gender-based differences may help physicians take steps to improve outcomes. Information derived from our study may also be useful for policymakers in directing healthcare funding to lower gaps in the care of patients such as those with peripheral vascular disease, ultimately leading to better health outcomes.