Heart failure & cardiomyopathies
Intersection of Patient and Hospital Rurality in Heart Failure Care and Outcomes
Main finding · All-cause mortality after hospitalizationResult — go to the resultOdds ratio 1.05 95% CI 1.02–1.08Authors' conclusion
Results suggest that hospital rurality was associated with lower odds of GDMT use and higher rates of all-cause mortality, whereas rural residence was associated with mortality differences despite treatment in urban hospitals. Interventions addressing both inpatient resource disparities and postdischarge transitions of care may reduce rural-urban inequities in HF outcomes.
Study context
- Population
- Medicare beneficiaries with HF with reduced ejection fraction (HFrEF) discharged alive after an index hospitalization for HFrEF in US hospitals, January 1, 2013, to December 31, 2021beneficiaries (median [IQR] age, 77 [70–85] years, 415,077 male [56.4%]) · rural-rural 69,061 (9.4%) · rural-urban 65,510 (8.9%) · urban-urban 582,947 (79.3%) · urban-rural 17,942 (2.4%)
- Participants
- 735,460 beneficiaries
- Exposure
- Patient rural residence and hospital rurality
- Rural-ruraln = 69,061reference
- Rural-urbann = 65,510
- Urban-urbann = 582,947reference
- Urban-ruraln = 17,942
- Outcome
- All-cause mortality after hospitalization
- Follow-up
- 90 days
Methodological detailsMedicare beneficiaries, US hospitals
- Medicare beneficiaries
- US hospitals
Main finding
As reported in the abstract
Odds ratio
1.05
95% CI 1.02–1.08
Rural-urban vs urban-urban
OR 1.05 (95% CI 1.02–1.08)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | |
|---|---|---|
| Inpatient cardiology consultationRural-urban vs rural-rural | 2.02 (1.84–2.22) | |
| Initiation of GDMT classesRural-urban vs rural-rural · β-blockers | 1.20 (1.16–1.25) | |
| Initiation of GDMT classesRural-urban vs rural-rural · ARNIs | 1.23 (1.13–1.34) | |
| Initiation of GDMT classesRural-urban vs rural-rural · MRAs | 1.23 (1.15–1.31) | |
| Initiation of GDMT classesRural-urban vs rural-rural · SGLT2Is | 1.48 (1.32–1.67) | |
| HF readmission and mortality · 1 yearRural-urban vs rural-rural · HF readmission | 0.85 (0.82–0.88) | |
| HF readmission and mortality · 1 yearRural-urban vs rural-rural · mortality | 0.91 (0.89–0.94) | |
| Inpatient cardiology consultationRural-urban vs urban-urban | 1.38 (1.31–1.44) | |
| HF readmission · 1 yearRural-urban vs urban-urban · lower HF readmission in rural patients | 0.81 (0.79–0.82) | |
| All-cause mortality · 30 daysRural-urban vs urban-urban · higher mortality in rural patients | 1.10 (1.06–1.14) | |
| 0.512Odds ratio (log scale) |
- Heart failure (HF) readmission and mortality: lower rates of HF readmission and mortality at all time points
Postdischarge guideline-directed medical therapy (GDMT) score
- Absolute difference in GDMT score, rural-urban vs urban-urban (differences modest; direction not stated in the abstract)
- 0.09 points; 95% CI, 0.05-0.14
Original publication
Intersection of Patient and Hospital Rurality in Heart Failure Care and Outcomes. JAMA Cardiol. Published 30 October 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →