title: In-hospital mortality among rural Medicare patients with acute myocardial infarction: the influence of demographics, transfer, and health factors.
abstract: CONTEXT/PURPOSE: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients.
  
  
  METHODS
  Cross-sectional retrospective analyses on 2003-2005 Medicare hospital inpatient data from 5 states were conducted to compare predictors of in-hospital AMI mortality between rural hospital transferred and nontransferred patients. A total of 9,690 rural hospital AMI patients were identified: 3,087 were transferred to receiving hospitals and 6,603 were not transferred. Separate logistic regressions were conducted for transferred and nontransferred patient cohorts and results were compared.
  
  
  RESULTS
  Transfer patients were younger, more likely male, had fewer comorbidities/complications, and were less likely to expire (5.3% vs 16.7%) in the hospital. Congestive heart failure and cardiac dysrhythmia were the most common comorbidities/complications among transfer and no-transfer AMI patients, but shock (OR = 9.44) and acute renal failure (OR = 3.67) had the strongest associations with in-hospital mortality for both cohorts. Undergoing a percutaneous coronary intervention (PCI) was associated with a 42% reduction in hospital mortality risk for transfer patients.
  
  
  CONCLUSIONS
  Transfer was associated with a greater likelihood of in-hospital AMI survival, largely but not fully explained by transfer patients being younger with fewer comorbidities/complications who are receiving advanced cardiac care. Additional studies are needed to clarify other factors that explain higher in-hospital mortality among nontransfers, such as patients' health care decision-making.
authors.affiliation: Center for Rural Health, University of North Dakota School of Medicine & Health Sciences, Grand Forks, North Dakota 58202, USA. klmuus@medicine.nodak.edu
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Muus
authors.forename: Alana D
authors.initials: AD
authors.lastname: Knudson
authors.forename: Marilyn G
authors.initials: MG
authors.lastname: Klug
authors.forename: Joshua
authors.initials: J
authors.lastname: Wynne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006304:Health Status; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population; D014481:United States / Q000453:epidemiology