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Heart disease outcomes similar for rural and urban patients, WCH study finds

Nov. 12, 2014

Heart disease patients in rural areas do not have higher risks of dying compared to heart disease patients in the city, new research suggests.

Researchers at Women’s College Hospital (WCH) and the Institute for Clinical Evaluative Sciences (ICES) looked at care and outcomes for urban and rural outpatients with heart disease. Their findings showed that even though there were some differences in how rural and urban patients accessed healthcare, there was no difference in mortality rates after one year.

The study, led by WCH cardiologist Dr. Sacha Bhatia, included 38,804 patients with stable ischemic heart disease (also known as coronary artery disease). The patients were each followed for one year, during which the researchers tracked their outpatient care for heart disease, as well as mortality rates, heart attacks, emergency department visits and inpatient hospitalizations. They then compared the results for the 34,949 urban patients to those of the 3,855 rural patients.

The results showed that the rural patients had fewer doctor visits, both for primary care and for cardiology. However, emergency department use was higher for rural patients than for urban patients. Rural patients also had lower rates of lab testing for both cholesterol levels and HbA1c, a test that measures blood glucose control. Their rates of statin medication use were also lower than urban patients’.

  • rural patients had 24 per cent fewer primary care visits than urban patients
  • rural patients had 29 per cent fewer cardiology visits than urban patients
  • rural patients’ emergency department use was 82 per cent higher than urban patients’
  • rural patients had 59 per cent lower rates of cholesterol and HbA1c testing than urban patients
  • rural patients’ statin use was 33 per cent lower than urban patients

Despite these differences in outpatient care, there was no difference in heart attacks, hospitalizations or mortality between the rural and urban groups.

The researchers note that the biggest difference between rural and urban patients was emergency department visits. They point out that this may be due to rural patients having less access to primary care and specialist doctors. There was no difference in hospital inpatient admissions between rural and urban patients, despite higher use of emergency departments in rural areas. This suggests that rural patients may use emergency departments for some services that would be provided in primary or specialist care for urban patients.

The study authors comment that their findings suggest that differences in care between rural and urban patients do not always mean that patient outcomes will be different. In their study, outcomes were the same for rural and urban coronary heart disease patients.

The study was published in the journal Circulation: Cardiovascular Quality and Outcomes on Oct. 28, 2014.

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  • A publication of:
  • Women's College Hospital