Association between Residence Location and Pre-Hospital Delay in Patients with Heart Failure.

Hyeongsuk Lee,Kyoung Suk Lee,Jae-Hyeong Park

doi:10.3390/ijerph18126679

Abstract

Rural residents with heart failure (HF) face more challenges than their urban counterparts in taking action when their symptoms worsen due to limited healthcare resources in rural areas. This may contribute to rural residents’ pre-hospital delay in seeking medical care. However, few studies have investigated the relationship between residence locations and pre-hospital delay among patients with HF. Therefore, this study determined whether living in rural areas is associated with pre-hospital delay in patients with HF. A retrospective electronic medical record review was conducted using the data of patients discharged with worsening HF from an academic medical center. Data on postal codes of the patients’ residences and their experiences before seeking medical care were obtained. Pre-hospital delay was calculated from the onset of HF symptoms to hospital arrival. A multivariate linear regression analysis was performed to determine the relationship between residence location and pre-hospital delay. The median pre-hospital delay time of all patients was 72 h (N = 253). About half of the patients did nothing to relieve their symptoms before seeking medical care. Living in urban areas was associated with a shorter pre-hospital delay. Patients with HF waited several days after first experiencing worsening of symptoms before getting admitted to a hospital, which may be related to inappropriate interpretation and responses to the worsening of symptoms. Furthermore, we found that rural residents were more vulnerable to pre-hospital delay than their urban counterparts.

Highlights

Recurrent hospitalizations are common in patients with heart failure (HF), and this increases direct and indirect costs of healthcare, leading to poor quality of life for patients with HF [1,2]
We found that rural patients with HF were more likely to have longer pre-hospital delay in seeking medical care than urban patients with HF, which can be explained by three reasons
Patients’ levels of understanding of HF and its relevant management could not be assessed through the electronic medical record review that we employed in this study, several results of our study suggest that rural residents had a limited understanding of HF

Summary

Introduction

Recurrent hospitalizations are common in patients with heart failure (HF), and this increases direct and indirect costs of healthcare, leading to poor quality of life for patients with HF [1,2]. The median time interval between recognizing the worsening of HF symptoms and seeking medical care ranges from 5.3 h to 7 days [4,5,6,7,8]. In the HF population, it has been reported that rural patients with HF are more likely to have a poor prognosis (e.g., rehospitalization) compared to their urban counterparts [10,11,12]. Since rural residents have limited access to healthcare resources such as medical care (e.g., because of long distance and lack of transportation), they are likely to face more challenges in taking actions than encountered by urban residents with HF when their symptoms worsen, which might lead to pre-hospital delay in seeking medical care.

Methods

Results

Discussion

Conclusion