Cohort study
Quality of Care and Outcomes Among Patients Hospitalized for Heart Failure in Rural vs Urban US Hospitals
- Retrospective cohort study
- registry-based (Get With The Guidelines-Heart Failure (GWTG-HF))
- 569 sites
Authors' conclusion
In this large contemporary cohort of US patients hospitalized for HF, care at rural hospitals was independently associated with lower use of some guideline-recommended therapies at discharge and shorter length of stay. In-hospital mortality and 30-day postdischarge outcomes were similar at rural and urban hospitals.
Study context
- Population
- US patients hospitalized for heart failure (HF) in the GWTG-HF registry, 2014–2021161,996 linked to Medicare
- Participants
- 774,419 patients
- Exposure
- Rural vs urban hospitals
- Ruraln = 19,832
- Urbann = 754,587reference
- Outcome
- GWTG-HF quality measures, in-hospital mortality, length of stay, and 30-day mortality and readmission
Main finding
As reported in the abstract
Rural vs UrbanAdjusted odds ratio (95% CI)
CRT prescribed at discharge; aRD −13.5%
0.44(0.22–0.92)
ACEi or ARB at discharge; aRD −3.7%
0.71(0.53–0.96)
ARNI at discharge; aRD −5.0%
0.68(0.47–0.98)
in-hospital mortality
0.86(0.70–1.07)
length of stay ≥4 days
0.75(0.67–0.85)
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| 30-day outcomes (Medicare beneficiaries) · 30 days — Rural vs Urban · HF readmission | 1.03 (0.90–1.19) | |
| 30-day outcomes (Medicare beneficiaries) · 30 days — Rural vs Urban · all-cause readmission | 0.97 (0.91–1.04) | |
| 30-day outcomes (Medicare beneficiaries) · 30 days — Rural vs Urban · all-cause mortality | 1.05 (0.91–1.21) | |
| 0.512Adjusted hazard ratio (log scale) |
- 30-day outcomes (Medicare beneficiaries): 161 996 linked to Medicare claims
Original publication
Quality of Care and Outcomes Among Patients Hospitalized for Heart Failure in Rural vs Urban US Hospitals. JAMA Cardiol. Published 1 April 2023. doi:10.1001/jamacardio.2023.0241
Summarised from the published abstract; every number is checked against it