Mortality Differences in AMI and HF Patients: Rural vs Urban Populations

Overview

This meta-analysis of 37 studies including over 39.5 million patients found that rural patients with acute myocardial infarction (AMI) and heart failure (HF) have significantly higher mortality rates compared to urban patients. The increased mortality risk persisted across various follow-up periods and geographic regions.

Background

Cardiovascular disease outcomes differ between rural and urban populations, potentially due to disparities in access to care and socioeconomic factors. Rural patients often face limited availability of life-saving interventions, higher comorbidity burdens, and reduced healthcare infrastructure. These challenges contribute to worse outcomes in acute myocardial infarction and heart failure, but the extent of mortality differences has not been systematically quantified until now.

Data Highlights

Key Findings

• Rural patients with AMI had a higher mortality rate at follow-up compared to urban patients (15.5% vs. 13.4%; OR 1.18).
• Rural patients with HF also had increased mortality compared to urban patients (12.3% vs. 11.6%; OR 1.11).
• Rural patients were more likely to be female and had similar mean ages compared to urban patients in both AMI and HF cohorts.
• High heterogeneity was observed across studies (I2 > 95%), reflecting variability in study designs and populations.
• Disparities in access to critical interventions, higher comorbidities, and socioeconomic factors likely contribute to worse outcomes in rural populations.
• Rural hospital closures and limited post-acute care resources exacerbate mortality risks for rural cardiac patients.

Clinical Implications

Clinicians should recognize the increased mortality risk faced by rural patients with AMI and HF and advocate for improved access to guideline-directed therapies and timely interventions. Healthcare systems and policymakers must prioritize resource allocation and infrastructure development in rural areas to reduce these disparities and improve cardiovascular outcomes.

Conclusion

This comprehensive meta-analysis confirms that rural residence is associated with higher mortality in patients with acute myocardial infarction and heart failure. Targeted clinical and policy efforts are essential to bridge the rural-urban gap in cardiovascular care and outcomes.

References

1. Loccoh et al. -- Rural vs Urban Disparities in Cardiac Interventions
2. Patterson et al. -- Physical Inactivity in Rural vs Urban Residents
3. Coppler et al. -- Geographic Access and Cardiac Mortality
4. Yusuf et al. -- Medication Use Post-Myocardial Infarction in Rural vs Urban Areas
5. Livori et al. -- Impact of Remoteness on Post-MI Medication Use