Abstract 12803: Disparities in Care Among COVID-19 Patients With ST-Elevation Myocardial Infarction Admitted in Rural and Urban Teaching Centers

Abstract

Introduction: During the pandemic of COVID-19, resources ran scarce in various regions, which impacted access and availability of treatment options. Our study aims to compare outcomes of COVID-19-positive patients (CPP) who reported a diagnosis of ST-elevation myocardial infarction (STEMI) in either rural centers (RC) or urban teaching centers(UTC). Methods: De-identified data of CPP adults with STEMI from the 2020 National Inpatient Sample for admissions between April-December 2020 were analyzed. Patient characteristics and outcomes between RC and UTC were compared. Results: We found 4690 STEMI cases among CPP. Most cases were hospitalized in UTC(4255 cases, 90.7%), with 9.3% seeking care RC (Table 1). Cases in UTC were younger (mean age 66.28 years) and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.31) than those at RC (mean age 71.75 years, p<0.01, mean CCI score 4.00, p<0.01). Medicare primarily covered both centers. A higher proportion of patients in RC were Whites (77.4%), while 50.0% of AMI cases at UTC were Whites. Patients at UTC also had a higher prevalence of prior stroke (6.3% vs. 3.4%, p=0.016) and lipid disorder (53.3% vs. 43.7%, p<0.01) than those in RC but showed a lower prevalence of diabetes (44.3% vs. 50.6%, p=0.012). No differences in the prevalence of prior myocardial infarction, hypertension, smoking, obesity, chronic kidney disease, and sex were noted. Cases in UTC reported a higher incidence of cardiogenic shock (18.2% vs. 3.4%, aOR 6.631, 95% CI 3.850-11.421, p<0.01), PCI use (42.1% vs. 20.7%, aOR 2.482, 95% CI 1.910-3.225, p<0.01), and death (44.4% vs. 40.2%, aOR 1.513, 95% CI 1.197-1.912, p<0.01). Conclusions: Adults with COVID-19 with STEMI admitted UTC were sicker with a higher mean CCI score and reported higher PCI use and mortality. Further studies investigating the distribution of resources during the pandemic and proposals to improve care access in rural and urban teaching hospitals should be conducted.