title: Is there a rural gradient in the diagnosis of aortic stenosis? An analysis of a remote Scottish cohort.
abstract: BACKGROUND
  Calcific aortic stenosis is the most common cardiac valve lesion and is becoming increasingly prevalent as life expectancy rises. There is evidence that patients in remote and rural areas with certain diseases have worse outcomes and present to specialist services later than their urban counterparts. It is not known whether patients with aortic stenosis follow a similar pattern. The aim of this study was to investigate whether increasing rurality was associated with later presentation to healthcare services at a more advanced stage of aortic stenosis.
  
  
  METHODS
  This was a retrospective cohort study. Using ICD-10 discharge codes and local databases, 605 patients with aortic stenosis who presented between 31 November 1999 and 1 December 2008 were identified. Aortic stenosis was defined as a pressure gradient across the aortic valve of 25 mmHg or more. Patients with prior aortic valve replacement were excluded. Clinical notes were reviewed for all patients. Gender, age and pressure gradient across the aortic valve at presentation and patient GP-practice location were recorded. Patients were then assigned a Clinical Peripherality Index score based on the postcode of their GP's practice to define rurality. Patient data were compared across the six defined levels of clinical peripherality by ANOVA.
  
  
  RESULTS
  Mean patient age was 73 ± 13 years, and 336 (54%) were male. The peak gradient across the valve was 41.1 ± 26.7 mmHg. There was no association between the level of clinical peripherality and the stage of aortic stenosis at presentation, age or gender (allp>0.05).
  
  
  CONCLUSIONS
  There was no urban-rural gradient in the severity of aortic stenosis at presentation in this remote Scottish cohort. This suggests that patients with this condition in remote areas do not present later in their disease trajectory.
authors.affiliation: Cardiac Unit, Raigmore Hospital, Inverness, Scotland, UK. matthew.maycock.05@aberdeen.ac.uk.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Maycock
authors.forename: Colin
authors.initials: C
authors.lastname: Farman
authors.forename: Alasdair
authors.initials: A
authors.lastname: Mort
authors.forename: David
authors.initials: D
authors.lastname: Turpie
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D062186:Arterial Pressure / Q000502:physiology; D002391:Catchment Area, Health; D015331:Cohort Studies; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data