Congestive heart failure-related hospital deaths across the urban-rural continuum in the United States

Abstract

Congestive heart failure (CHF) is a growing public health problem that affects nearly 6.5 million individuals nationwide. Access to quality outpatient care and disease management programs has been shown to improve disease treatment and prognosis. Rural populations face unique challenges in the availability and accessibility of quality cardiovascular care. In 2018, we conducted a pooled cross-sectional analysis of the Nationwide Inpatient Sample (NIS) for 2009–2014 to examine recent trends in CHF-related hospital deaths in the United States, highlighting urban-rural differences within each census region. We performed a multivariable logistic regression analysis to compare the odds of CHF-related hospital death, by levels of rurality and within each census region. Most CHF-related hospital deaths occurred in the South and Midwest census regions and in large central metropolitan areas. Findings from census region stratified models revealed that non-core residents living within the West (OR 1.47, CI 1.26, 1.71), Midwest (OR 1.30, CI 1.17, 1.44), and South (OR = 1.21, 95% C.I. = 1.12–1.32) had a higher relative risk (but not higher absolute numbers) of experiencing death during a CHF-related hospitalization, compared to patients in large central metropolitan areas. Within each census region, there were also differences in odds of a CHF-related hospital death depending on patient sex, comorbidities, insurance type, median annual income, and year. As efforts to reduce rural health disparities in CHF morbidity continue, more work is needed to understand and test interventions to reduce the risk of death from CHF in noncore areas of the West, Midwest, and South.

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

“…Residents of rural communities in the West (OR, 1.47), Midwest (OR, 1.30), and South (OR, 1.21) have higher mortality risk during HF hospitalizations compared with residents of large metropolitan areas. 77…”

Association of Rurality With Risk of Heart Failure

“…Prior research on HF within rural communities has focused mainly on mortality outcomes . However, research on HF incidence among rural residents within the United States is relatively limited.…”

“…Prior research identified that HF mortality was increased among rural residents [8][9][10]29 ; our results bring new knowledge to this domain by demonstrating that rural residents have a higher rate of HF incidence, with race-sex variation. Our results resonate with the call for primary prevention as a strategy to reduce HF health inequities put forth by Youmans et al 48 and provide important practical strategies to do so.…”

Quality of Care Before and After Mergers and Acquisitions of Rural Hospitals

“…With reduced access to care, rural residents with these conditions are at greater risk of death than their urban counterparts. 36 , 37 Mergers can allow partnerships with urban hospitals to facilitate implementation of clinical pathways and protocols for improving patient outcomes. 38 Through mergers, rural hospitals can also gain access to capital investment in electronic health records and clinical decision support systems for enhancing technological capabilities.…”

“…Heart failure and pneumonia are high-volume conditions in rural areas with aging populations, and ensuring timely initial evaluation and treatment for acute stroke is particularly challenging. With reduced access to care, rural residents with these conditions are at greater risk of death than their urban counterparts . Mergers can allow partnerships with urban hospitals to facilitate implementation of clinical pathways and protocols for improving patient outcomes .…”