ABSTRACT
The purpose of this study was to compare 136 frontier and 148 urban patients with chronic heart failure who were aged 60 years and older. Medical records from 2000 to 2002 were reviewed from a regional tertiary hospital in Montana. While the two groups did not differ with respect to New York Heart Association functional class and number of comorbid conditions, the frontier sample was more likely to be male, married, and younger. Frontier patients were more depressed and scored significantly lower on quality-of-life measures. Among those who had died, frontier patients survived an average of 7.7 months, in contrast to urban patients who survived an average of 13.4 months following index hospitalization. Frontier patients have few available health care services and providers may not treat patients as expertly or aggressively as urban providers. Frontier patients tend to be isolated due to illness, lack of transportation, travel distances, and weather-related barriers. Many may be falling through the cracks.
