This study is supported by a grant from the Agency for Healthcare Research and Quality (5 P20 HS015931). The sponsor was not involved in the management, analysis/interpretation of data or the preparation of the manuscript. The authors thank Mary Wakefield, PhD, RN, for her helpful comments and suggestions. For further information, contact: Dr. Kyle J. Muus, PhD, University of North Dakota Center for Rural Health, School of Medicine & Health Sciences, 501 North Columbia Road, Grand Forks, ND 58202; e-mail email@example.com.
In-Hospital Mortality Among Rural Medicare Patients With Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors
Article first published online: 4 JAN 2011
© 2011 National Rural Health Association
The Journal of Rural Health
Volume 27, Issue 4, pages 394–400, Autumn 2011
How to Cite
Muus, K. J., Knudson, A. D., Klug, M. G. and Wynne, J. (2011), In-Hospital Mortality Among Rural Medicare Patients With Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors. The Journal of Rural Health, 27: 394–400. doi: 10.1111/j.1748-0361.2010.00351.x
- Issue published online: 3 OCT 2011
- Article first published online: 4 JAN 2011
- myocardial infarction;
- risk factors;
- rural hospitals;
Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients.
Methods: Cross-sectional retrospective analyses on 2003-2005 Medicare hospital inpatient data from 5 states were conducted to compare predictors of in-hospital AMI mortality between rural hospital transferred and nontransferred patients. A total of 9,690 rural hospital AMI patients were identified: 3,087 were transferred to receiving hospitals and 6,603 were not transferred. Separate logistic regressions were conducted for transferred and nontransferred patient cohorts and results were compared.
Results: Transfer patients were younger, more likely male, had fewer comorbidities/complications, and were less likely to expire (5.3% vs 16.7%) in the hospital. Congestive heart failure and cardiac dysrhythmia were the most common comorbidities/complications among transfer and no-transfer AMI patients, but shock (OR = 9.44) and acute renal failure (OR = 3.67) had the strongest associations with in-hospital mortality for both cohorts. Undergoing a percutaneous coronary intervention (PCI) was associated with a 42% reduction in hospital mortality risk for transfer patients.
Conclusions: Transfer was associated with a greater likelihood of in-hospital AMI survival, largely but not fully explained by transfer patients being younger with fewer comorbidities/complications who are receiving advanced cardiac care. Additional studies are needed to clarify other factors that explain higher in-hospital mortality among nontransfers, such as patients’ health care decision-making.