TY - JOUR
T1 - Quality of Care and In-Hospital Outcomes in Patients With Coronary Heart Disease in Rural and Urban Hospitals (from Get With the Guidelines-Coronary Artery Disease Program)
AU - Ambardekar, Amrut V.
AU - Fonarow, Gregg C.
AU - Dai, David
AU - Peterson, Eric D.
AU - Hernandez, Adrian F.
AU - Cannon, Christopher P.
AU - Krantz, Mori J.
N1 - Funding Information:
The Get With the Guidelines-Coronary Artery Disease Program is supported by the American Heart Association, Dallas, Texas, in part through an unrestricted education grant from the Merck Schering Plough Partnership, North Wales, Pennsylvania, who did not participate in the design, analysis, preparation, review, or approval of this report. Dr. Ambardekar is supported by a 2009 Research Fellowship Award from the Heart Failure Society of America, Saint Paul, Minnesota.
PY - 2010/1/15
Y1 - 2010/1/15
N2 - Previous studies have suggested that patients with coronary artery disease (CAD) in rural areas may have worse outcomes due to limited availability of specialists, fewer resources, and less institutional funding. Data were collected from hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program (GWTG-CAD) from January 2000 to December 2008. In-hospital outcomes and quality of care were stratified by care at rural versus urban hospitals. Multivariate logistic regression analysis was used to determine the association of rural locale with in-hospital mortality, length of stay, and compliance with the GWTG-CAD performance measurements including (1) early aspirin use, (2) smoking cessation counseling and discharge prescriptions of (3) aspirin, (4) angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers for left ventricular systolic dysfunction, (5) β-blockers, and (6) lipid-lowering therapy and a composite of all 6 measurements. Data were collected from 22,096 patients at 71 rural centers and 329,938 patients at 477 urban centers. Unadjusted rates of compliance with performance measurements were lower in rural (range 82.4% to 90.5%) compared to urban (range 81.3% to 95.0%) hospitals including the composite (74.7% vs 80.6%, p <0.0001). In multivariate analysis, rural status was not independently associated with lower compliance with any of the performance measurements. Unadjusted mortality rates were higher in rural versus urban hospitals (5.7% vs 4.4%, p <0.0001), but this was not significant in multivariate analysis (odds ratio 1.05, 95% confidence interval 0.87 to 1.26). In conclusion, within the GWTG-CAD quality improvement initiative, patients with CAD treated at rural hospitals receive similar quality of care and have similar outcomes as those at urban centers.
AB - Previous studies have suggested that patients with coronary artery disease (CAD) in rural areas may have worse outcomes due to limited availability of specialists, fewer resources, and less institutional funding. Data were collected from hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program (GWTG-CAD) from January 2000 to December 2008. In-hospital outcomes and quality of care were stratified by care at rural versus urban hospitals. Multivariate logistic regression analysis was used to determine the association of rural locale with in-hospital mortality, length of stay, and compliance with the GWTG-CAD performance measurements including (1) early aspirin use, (2) smoking cessation counseling and discharge prescriptions of (3) aspirin, (4) angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers for left ventricular systolic dysfunction, (5) β-blockers, and (6) lipid-lowering therapy and a composite of all 6 measurements. Data were collected from 22,096 patients at 71 rural centers and 329,938 patients at 477 urban centers. Unadjusted rates of compliance with performance measurements were lower in rural (range 82.4% to 90.5%) compared to urban (range 81.3% to 95.0%) hospitals including the composite (74.7% vs 80.6%, p <0.0001). In multivariate analysis, rural status was not independently associated with lower compliance with any of the performance measurements. Unadjusted mortality rates were higher in rural versus urban hospitals (5.7% vs 4.4%, p <0.0001), but this was not significant in multivariate analysis (odds ratio 1.05, 95% confidence interval 0.87 to 1.26). In conclusion, within the GWTG-CAD quality improvement initiative, patients with CAD treated at rural hospitals receive similar quality of care and have similar outcomes as those at urban centers.
UR - http://www.scopus.com/inward/record.url?scp=73149083944&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=73149083944&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2009.09.003
DO - 10.1016/j.amjcard.2009.09.003
M3 - Article
C2 - 20102907
AN - SCOPUS:73149083944
SN - 0002-9149
VL - 105
SP - 139
EP - 143
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -