According to research published in the Journal of the American College of Cardiology, older adults at rural hospitals are less likely to receive essential procedures and treatments for heart attack and stroke.
In a nationwide study of Medicaid beneficiaries, researchers at Beth Israel Deaconess Medical Center (BIDMC) performed a retrospective cross-sectional study to evaluate the differences in procedural care and mortality for acute cardiovascular conditions between rural and urban hospitals. Wadhera, Loccoh, and colleagues looked at data from more than two million Medicare beneficiaries aged sixty-five and older hospitalized with acute cardiovascular conditions at more than four thousand urban and rural hospitals across the US from 2016 to 2018.
The researchers found significant disparities in the treatment of patients with rural and urban patients. This finding demonstrates that older adults initially presenting at rural hospitals are less likely to receive essential procedures and treatments for heart attack and stroke. Furthermore, the researchers found that mortality rates were also higher at rural hospitals for patients presenting with heart attack, heart failure, or stroke than at urban hospitals.
According to the researchers, medicare beneficiaries admitted to rural hospitals with acute cardiovascular diseases were older, more likely to be female, and more likely to be white than those in urban areas. These patients were also less likely to obtain procedural care, such as cardiac catheterization for heart attack patients or thrombolysis and endovascular therapy for stroke patients.
The researchers noted that several factors might contribute to worse outcomes in rural areas, despite significant public health and policy efforts to reduce rural-urban inequities. Some of the identified factors include a decline in primary care physicians and specialties, which make access to follow-up care after discharge more difficult. A string of rural hospital closures in the previous decade led to lengthier travel times, delays in emergency medical services and treatments, and a lack of resources and infrastructure in the rural setting.
“Although public health and policy efforts to improve rural health have intensified over the past decade, our findings highlight that large gaps in clinical outcomes for cardiovascular conditions remain in the United States,” the corresponding author Rishi K. Wadhera wrote, “These disparities suggest that rural adults continue to face challenges accessing the care they need for urgent conditions, an issue that has likely been magnified by the rapid rise in rural hospital closures over the last decade.”
Disclosure: Some authors received personal fees from Biosense Webster, grants, and personal fees from Abbott Vascular, AstraZeneca, Boston Scientific, and Medtronic outside the submitted work. The corresponding author serves as a consultant for Abbott outside the submitted work.
