Document Type

Journal Article

Date of this Version

12-2010

Publication Source

Heart & Lung: The Journal of Acute and Critical Care

Volume

39

Issue

6

Start Page

512

Last Page

520

DOI

10.1016/j.hrtlng.2009.11.002

Abstract

Background

Evidence of health disparities between urban and rural populations usually favors urban dwellers. The impact of rurality on heart failure (HF) outcomes is unknown.

Objective

We compared event-free survival between HF patients living in urban and rural areas.

Methods

In this longitudinal study, 136 patients with HF (male, 70%; age, mean ± SD 61 ± 11 years; New York Heart Association class III/IV, 60%) were enrolled. Patients' emergency department visits for HF exacerbation and rehospitalization during follow-up were identified. Rural status was determined by rural-urban commuting area code. Survival analysis was used to determine the effect of rurality on outcomes while controlling for relevant demographic, clinical, and psychosocial variables.

Results

Rural patients (64%) had longer event-free survival than urban patients (P = .015). Rurality (P = .04) predicted event-free survival after controlling for age, marital status, New York Heart Association class, medications, adherence to medications, depressive symptoms, and social support.

Conclusions

Rural patients were less likely than their urban counterparts to experience an event. Further research is needed to identify protective factors that may be unique to rural settings.

Copyright/Permission Statement

NOTICE: This is the author’s version of a work that was accepted for publication in Heart & Lung. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in JHeart & Lung, 2010, 39, 512-520, doi: 10.1016/j.hrtlng.2009.11.002

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Date Posted: 01 June 2016

This document has been peer reviewed.