Back to Search
Start Over
Rural‐urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study.
- Source :
- Journal of Rural Health; Sep2023, Vol. 39 Issue 4, p844-852, 9p
- Publication Year :
- 2023
-
Abstract
- Purpose: To compare longitudinal rates of health care utilization, evidence‐based treatment, and mortality between rural and urban‐dwelling patients with congestive heart failure (CHF). Methods: We used electronic medical record data from the Veterans Health Administration (VHA) to identify adult patients with CHF from 2012 through 2017. We stratified our cohort using left ventricular ejection fraction percentage at diagnosis (<40% = reduced ejection fraction [HFrEF]; 40%‐50% = midrange ejection fraction [HFmrEF]; >50% = preserved ejection fraction [HFpEF]). Within each ejection fraction cohort, we stratified patients into rural or urban groups. We used Poisson regression to estimate annual rates of health care utilization and CHF treatment. We used Fine and Gray regression to estimate annual hazards of CHF and non‐CHF mortality. Findings: One‐third of patients with HFrEF (N = 37,928/109,110), HFmrEF (N = 24,447/68,398), and HFpEF (N = 39,298/109,283) resided in a rural area. Rural compared to urban patients used VHA facilities at similar or lower annual rates for outpatient specialty care across all ejection fraction cohorts. Rural patients used VHA facilities at similar or higher rates for primary care and telemedicine‐delivered specialty care. They also had lower and declining rates of VHA inpatient and urgent care use over time. There were no meaningful rural‐urban differences in treatment receipt among patients with HFrEF. On multivariable analysis, the rate of CHF and non‐CHF mortality was similar between rural and urban patients in each ejection fraction cohort. Conclusions: Our findings suggest the VHA may have mitigated access and health outcome disparities typically observed for rural patients with CHF. [ABSTRACT FROM AUTHOR]
- Subjects :
- HEART failure treatment
AMERICAN veterans
LEFT heart ventricle
HEALTH services accessibility
OUTPATIENT medical care
MULTIVARIATE analysis
LEFT ventricular dysfunction
EVIDENCE-based medicine
RETROSPECTIVE studies
REGRESSION analysis
PATIENTS' attitudes
COMPARATIVE studies
INDEPENDENT living
DESCRIPTIVE statistics
RESEARCH funding
ELECTRONIC health records
STROKE volume (Cardiac output)
HEART physiology
HEART failure
RURAL population
LONGITUDINAL method
TELEMEDICINE
Subjects
Details
- Language :
- English
- ISSN :
- 0890765X
- Volume :
- 39
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Journal of Rural Health
- Publication Type :
- Academic Journal
- Accession number :
- 172022369
- Full Text :
- https://doi.org/10.1111/jrh.12756