Relationship between the place of living and mortality in patients with advanced heart failure

Abstract

Background: Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease. Methods: Population-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least 1 year after reaching New York Heart Association IV functional class, between 2010 and 2014. Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality. Results: Mean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged > 74 years (p = 0.036), and presented lower comorbidity. Mortality percentages were 59 and 51% among rural and urban patients, respectively (p = 0.030). Urban patients living in the most socioeconomically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend < 0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk. Conclusions: Living in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

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

“…Inequitable rural access to health-relevant resources (e.g., distance to the nearest hospital or ratios of healthcare providers to population) results in poorer health status for people living in rural areas [ 9 ]. 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.…”