People treated for heart problems at rural hospitals fare about as well as those getting care at urban medical centers, a study of U.S. hospitals suggests.
Some research has suggested that heart attack patients at rural hospitals are less likely to get all of the recommended treatments, and have higher short-term death rates, than their counterparts treated at urban centers.
But in the current study, which followed outcomes at 548 hospitals over eight years, researchers found that patients at rural and urban centers had similar quality of care and survival odds.
The more than 350,000 patients in the study were treated for a variety of heart problems, including heart attack, severe chest pain called unstable angina, and blocked heart arteries requiring surgery.
Among patients at 477 urban hospitals, 4.5 percent died in the hospital, compared with 5.7 percent of those at 71 rural centers.
However, when the researchers accounted for other factors -- including patients' ages and co-existing medical problems -- there was no significant difference in rural and urban patients' risk of dying.
Patients at rural hospitals tended to be older and had higher rates of heart failure -- a chronic condition in which the heart muscle is weakened -- and atrial fibrillation, a common type of heart-rhythm disturbance.
Researchers led by Dr. Amrut V. Ambardekar, of the University of Colorado Health Sciences Center in Denver, report the findings in the American Journal of Cardiology.
There were differences between rural and urban hospitals' facilities; only 46 percent of rural centers provided onsite cardiac surgery, for example, compared with 82 percent of urban centers.
But the findings suggest that the rural setting, itself, does not mean inferior care or a higher death risk, according to Ambardekar's team. Similar patients getting similar procedures at rural and urban centers fare equally well.
When it came to providing patients' guideline-recommended therapies -- such as giving aspirin within 24 hours of heart attack symptoms, smoking-cessation counseling and prescriptions for blood pressure and cholesterol drugs when appropriate -- rural centers did have lower rates.
But again, when the researchers accounted for patients' health and other characteristics, there was no substantial difference in the odds of getting recommended therapies.
The findings, the researchers write, suggest that despite previous conflicting reports, (coronary artery disease) care among the nation's rural hospitals is equivalent to that in urban centers.
SOURCE: American Journal of Cardiology, online November 16, 2009.