Abstract 16488: Rural-urban Disparities in Hospital Care and Mortality Among Older Adults With Acute Myocardial Infarction, Heart Failure, and Ischemic Stroke in the United States

Abstract

Introduction: Over the last decade, disparities in cardiovascular mortality have widened between rural and urban areas of the US. Our objective was to determine whether there were differences in treatment patterns and outcomes for acute cardiovascular conditions at rural and urban hospitals. Methods: We used 100% Medicare Claims to identify beneficiaries age 65 years hospitalized 1/1/2016-12/31/2017 for acute myocardial infarction (AMI), heart failure (HF), and ischemic stroke. We fit a mixed effects model with a logit link function and hospital random intercepts to evaluate condition-specific procedure rates (PCI/CABG, cerebral arteriography, systemic thrombolysis) and 30-day and 1-year mortality rates for beneficiaries admitted to rural vs. urban hospitals, adjusted for age, sex, dual enrollment, and clinical comorbidities. Results: Our study included 398,673 beneficiaries hospitalized for AMI (mean age 77.3 years), 690,218 for heart failure (80.3 years), and 378,170 for stroke (79.4 years). The proportion of AMI, HF, and stroke hospitalizations that occurred at rural hospitals was 10.7%, 14.2%, and 10.6%. Procedures were performed less frequently for beneficiaries admitted to rural compared with urban hospitals (PCI/CABG within 30 days of AMI: adjusted odds ratio [aOR] 0.50, 95% CI 0.47-0.54; cerebral arteriography [aOR 0.15, 0.11-0.22]; and systemic thrombolysis [aOR 0.47, 0.43-0.52] for stroke). Thirty-day mortality was higher at rural vs. urban hospitals for AMI (aOR 1.26, 1.21-1.31), HF (aOR 1.14, 1.11-1.17) and stroke (aOR 1.11, 1.07-1.16), as was 1-year mortality (AMI: aOR 1.31, 1.26-1.35; HF: aOR 1.10, 1.08-1.12; Stroke: aOR 1.14, 1.10-1.17). Conclusion: Older adults admitted to rural hospitals for acute cardiovascular conditions receive lower intensity care and experience higher mortality rates than those admitted to urban hospitals. Policy initiatives that improve cardiovascular care at rural hospitals are urgently needed.