Document Detail


Mortality and revascularization following admission for acute myocardial infarction: implication for rural veterans.
MedLine Citation:
PMID:  21029165     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition.
METHODS: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables.
RESULTS: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93).
CONCLUSION: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans.
Authors:
Thad E Abrams; Mary Vaughan-Sarrazin; Peter J Kaboli
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-08-17
Journal Detail:
Title:  The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association     Volume:  26     ISSN:  1748-0361     ISO Abbreviation:  J Rural Health     Publication Date:  2010  
Date Detail:
Created Date:  2010-10-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8508122     Medline TA:  J Rural Health     Country:  United States    
Other Details:
Languages:  eng     Pagination:  310-7     Citation Subset:  IM    
Copyright Information:
© 2010 National Rural Health Association.
Affiliation:
VA Office of Rural Health, Midwest Rural Health Resource Center, Iowa City VA Medical Center, Iowa City, Iowa 52246, USA. Thad-Abrams@uiowa.edu
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