Rural-urban disparities in baseline health factors and procedure outcomes

Background: Rural populations have known challenges to both emergency and ambulatory care access resulting in delayed presentation and poorer outcomes for stroke and heart attack patients. Conditions such as diabetes and hypertension are known to be more common among rural populations. However, it is unclear whether there are any differences in underlying clinical factors and outcomes among patients presenting to a tertiary care center for advanced cardiac procedures from rural versus urban areas. Objective: We sought to assess rural-urban disparities in baseline health factors and outcomes in patients presenting for cardiac procedures. Design and participants: We performed a retrospective study of 1775 patients who presented directly or were transferred to University of Tennessee Medical Center between July 2018 to October 2019 from rural/Appalachian or urban areas for heart catheterization and stent procedures. We compared these rural to urban cardiac patients on baseline factors (diabetes, hypertension, stroke, vascular disease, prior bypass surgery and heart failure) and outcomes (number of patients receiving stents, procedure times, bleeding complications, and mortality). Key results: Rural residents had more vascular disease, prior bypass surgery and worse outcomes requiring significantly more stents (8.55% vs 34.36%, P = < 0.001; OR 5.51 CI 4.13 to 7.34), longer procedure times (14.86 +/- 11.69 mins vs 12.59 +/- 14.87 mins, P = 0.04), and had more bleeding complications (1.6% vs 0.4%, p = < 0.001), and higher mortality (2.2% vs 0.7%, p = 0.02). Conclusions: Our study identified rural-urban differences in baseline factors and procedural outcomes in patients presenting to a tertiary care center for cardiac procedures. Providers should anticipate that health disparities may be associated with more intervention and worse outcomes in their rural patients. Being aware of such differences may also help policy makers in directing health care funding to lower gaps in health care and access ultimately leading to better health outcomes.