title: Rurality and event-free survival in patients with heart failure.
abstract: BACKGROUND
  Evidence of health disparities between urban and rural populations usually favors urban dwellers. The impact of rurality on heart failure (HF) outcomes is unknown.
  
  
  OBJECTIVE
  We compared event-free survival between HF patients living in urban and rural areas.
  
  
  METHODS
  In this longitudinal study, 136 patients with HF (male, 70%; age, mean ± SD 61 ± 11 years; New York Heart Association class III/IV, 60%) were enrolled. Patients' emergency department visits for HF exacerbation and rehospitalization during follow-up were identified. Rural status was determined by rural-urban commuting area code. Survival analysis was used to determine the effect of rurality on outcomes while controlling for relevant demographic, clinical, and psychosocial variables.
  
  
  RESULTS
  Rural patients (64%) had longer event-free survival than urban patients (P = .015). Rurality (P = .04) predicted event-free survival after controlling for age, marital status, New York Heart Association class, medications, adherence to medications, depressive symptoms, and social support.
  
  
  CONCLUSIONS
  Rural patients were less likely than their urban counterparts to experience an event. Further research is needed to identify protective factors that may be unique to rural settings.
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA. jiarongw@email.unc.edu
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Wu
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Rayens
authors.forename: Marla J
authors.initials: MJ
authors.lastname: De Jong
authors.forename: Misook L
authors.initials: ML
authors.lastname: Chung
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D005260:Female; D005843:Geography; D054624:Health Status Disparities; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality* / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D010414:Pennsylvania / Q000453:epidemiology; D016016:Proportional Hazards Models; D011594:Psychometrics; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology