title: Quality of care and in-hospital outcomes in patients with coronary heart disease in rural and urban hospitals (from Get With the Guidelines-Coronary Artery Disease Program).
abstract: Previous studies have suggested that patients with coronary artery disease (CAD) in rural areas may have worse outcomes due to limited availability of specialists, fewer resources, and less institutional funding. Data were collected from hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program (GWTG-CAD) from January 2000 to December 2008. In-hospital outcomes and quality of care were stratified by care at rural versus urban hospitals. Multivariate logistic regression analysis was used to determine the association of rural locale with in-hospital mortality, length of stay, and compliance with the GWTG-CAD performance measurements including (1) early aspirin use, (2) smoking cessation counseling and discharge prescriptions of (3) aspirin, (4) angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers for left ventricular systolic dysfunction, (5) beta-blockers, and (6) lipid-lowering therapy and a composite of all 6 measurements. Data were collected from 22,096 patients at 71 rural centers and 329,938 patients at 477 urban centers. Unadjusted rates of compliance with performance measurements were lower in rural (range 82.4% to 90.5%) compared to urban (range 81.3% to 95.0%) hospitals including the composite (74.7% vs 80.6%, p <0.0001). In multivariate analysis, rural status was not independently associated with lower compliance with any of the performance measurements. Unadjusted mortality rates were higher in rural versus urban hospitals (5.7% vs 4.4%, p <0.0001), but this was not significant in multivariate analysis (odds ratio 1.05, 95% confidence interval 0.87 to 1.26). In conclusion, within the GWTG-CAD quality improvement initiative, patients with CAD treated at rural hospitals receive similar quality of care and have similar outcomes as those at urban centers.
authors.affiliation: Division of Cardiology, Denver Health Medical Center, The University of Colorado at Denver and the Health Sciences Center, Denver, Colorado, USA. Amrut.Ambardekar@ucdenver.edu
authors.forename: Amrut V
authors.initials: AV
authors.lastname: Ambardekar
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D008297:Male; D009204:Myocardial Revascularization; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents