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Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

Authors

  • Thad E. Abrams MD, MS,

    1. VA Office of Rural Health, Midwest Rural Health Resource Center, Iowa City VA Medical Center, Iowa City, Iowa
    2. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa city, Iowa
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  • Mary Vaughan-Sarrazin PhD,

    1. VA Office of Rural Health, Midwest Rural Health Resource Center, Iowa City VA Medical Center, Iowa City, Iowa
    2. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa city, Iowa
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  • Peter J. Kaboli MD, MS

    1. VA Office of Rural Health, Midwest Rural Health Resource Center, Iowa City VA Medical Center, Iowa City, Iowa
    2. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa city, Iowa
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  • The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Rural Health Resource Center. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. For further information, contact: Thad E. Abrams, MD, MS, Iowa City VAMC, Iowa City, IA 52246; e-mail Thad-Abrams@uiowa.edu.

Abstract

Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition.

Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables.

Results: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93).

Conclusion: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans.

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