Breaking News
March 22, 2018 - ENDO: Big Breakfast May Help in Diabetics
March 22, 2018 - I’m not overweight, so why do I need to eat healthy foods?
March 22, 2018 - UCLA-led study suggests unexpected reason for reduction in cardiovascular health disparities
March 22, 2018 - Study suggests detailed neuropsychological assessment for brief cardiac arrest survivors
March 22, 2018 - Anticoagulant drugs found safe to use in patients undergoing surgery for irregular heartbeat
March 22, 2018 - SP Industries appoints Brian Larkin as new President and CEO
March 22, 2018 - GTx Announced New Data Demonstrating Enobosarm’s Potential to Treat Stress Urinary Incontinence
March 22, 2018 - Higher Risk of Brain Deficits in Older Alcoholics
March 22, 2018 - Top US health official resigns in conflict of interest
March 22, 2018 - Study shows benefits of hair loss drug in improving cognitive function and vascular health
March 22, 2018 - Researchers explain link between 2 key Alzheimer’s proteins
March 22, 2018 - Patients on replacement therapy with thyroid hormone may have more comorbidities
March 22, 2018 - Higher online patient ratings linked to urologists who saw fewer Medicare patients
March 22, 2018 - FDA Approves Ilumya (tildrakizumab-asmn) for the Treatment of Moderate-to-Severe Plaque Psoriasis
March 22, 2018 - Beer Raises Heart Rate; KardiaBand Hyperkalemia Test; CHD Clinics
March 22, 2018 - A retinal implant that is more effective against blindness
March 22, 2018 - New system based on artificial intelligence provides reliable detection of breast cancer
March 22, 2018 - Research offers new understanding about cause of Parkinson’s disease
March 22, 2018 - HORIBA’s Microsemi CRP analyzer improves quality of care in emergency pediatric units, study shows
March 22, 2018 - Neuroscientists move closer to developing tools for deciphering brain function
March 22, 2018 - New test methods with less fear
March 22, 2018 - Range of Vaginal Dryness Products Can Help Postmenopausal Women: Study
March 22, 2018 - Higher Dose Tx Deemed Safe in Pulmonary TB
March 22, 2018 - Discovery of new ALS gene points to cytoskeleton as potential target for drug development
March 22, 2018 - Diet soda associated with higher odds of diabetic retinopathy
March 22, 2018 - LSD reduces ‘sense of self’
March 22, 2018 - Vitamin D deficiency linked to metabolic syndrome in postmenopausal women
March 22, 2018 - Changes in the intestines may be responsible for reversal of diabetes after bariatric surgery
March 22, 2018 - iPads and Cancer; Clot Retrieval and Stroke: It’s PodMed Double T!
March 22, 2018 - Premature births linked to changes in mother’s bacteria
March 22, 2018 - Brain SPECT scans predict treatment outcomes in patients with depression
March 21, 2018 - Researchers succeed in integrating artificial organelles into cells of living organism
March 21, 2018 - Researchers discover ‘missing mutation’ in severe infant epilepsy
March 21, 2018 - Researchers develop statistics-based computational scheme to zoom in on brain function
March 21, 2018 - Verge joins Genomics England’s Discovery Forum industry partnership
March 21, 2018 - Trovagene Announces First Patient Successfully Completes Cycle 1 of Treatment with PCM-075 in Combination with Low Dose Cytarabine (LDAC) in AML Trial
March 21, 2018 - Congenital Cardiac Cath Tx Often Strays from Guidelines
March 21, 2018 - Marked increase in cardiovascular risk factors in women after preeclampsia
March 21, 2018 - New app may help predict, track manic and depressive episodes in bipolar patients
March 21, 2018 - Discovery of genes could lead to development of novel therapies for EBV-related cancers
March 21, 2018 - High-fat, high-cholesterol diet depletes ranks of artery-protecting immune cells
March 21, 2018 - Research misconduct allegations shadow likely CDC appointee
March 21, 2018 - Most Breast Ca Patients Fail to Get Genetic Counseling
March 21, 2018 - Lopsided ear function can lead to lopsided brain development
March 21, 2018 - Acupuncture helps manage menopausal symptoms, review finds
March 21, 2018 - Motor skill training may contribute to reading skills in obese children
March 21, 2018 - Poor dental health may be related to increased diabetes risk
March 21, 2018 - Chronic opioid users at increased risk of complications after spinal fusion surgery
March 21, 2018 - Study uncovers potential therapeutic target against large family of parasites
March 21, 2018 - NSAID use linked to increased risk of atrial fibrillation
March 21, 2018 - Scientists develop brain “stethoscope” that can detect silent seizures
March 21, 2018 - New method predicts effects of global warming on disease
March 21, 2018 - Insurance Company Hurdles Burden Doctors, May Harm Patients
March 21, 2018 - Renal Transplant from HCV-Positive Donors Feasible
March 21, 2018 - Myelodysplastic syndrome: MedlinePlus Medical Encyclopedia
March 21, 2018 - Research reveals brain mechanism involved in language learning
March 21, 2018 - Many parents still hesitate to try early peanut introduction, survey finds
March 21, 2018 - Audiologist urges tinnitus sufferers facing ‘revolving door healthcare’ to seek support
March 21, 2018 - Study reveals impact of prostate cancer on wives and partners of sufferers
March 21, 2018 - ‘Almost a Miracle Drug’: What We Heard This Week
March 21, 2018 - Study shows NIH spent >$100 billion on basic science for new medicines
March 21, 2018 - Columbia researchers identify nerve cells that drive fruit fly’s escape behavior
March 21, 2018 - Sartorius Stedim Biotech selected by ABL Europe to supply single-use process technologies
March 21, 2018 - Increase in coffee consumption may help battle against colon cancer
March 21, 2018 - Hydrogel may accelerate healing of diabetic ulcers
March 21, 2018 - Dermira’s Two Phase 3 Trials Evaluating Olumacostat Glasaretil in Patients with Acne Vulgaris Did Not Meet Co-Primary Endpoints
March 21, 2018 - DePuy Synthes introduces ACTIS Total Hip System for improving initial implant stability
March 21, 2018 - ‘Oh, It Was Nothing’
March 21, 2018 - Herbal drug kratom linked to salmonella illnesses, CDC says
March 21, 2018 - New optical point-of-care device could enhance screening for thyroid nodules
March 21, 2018 - FDA Expands Approval of Adcetris (brentuximab vedotin) for First-Line Treatment of Stage III or IV Classical Hodgkin Lymphoma in Combination with Chemotherapy
March 21, 2018 - Eosinophilic Esophagitis: Late Manifestation of Allergic March
March 21, 2018 - Signaling pathway involving the Golgi apparatus identified in cells with Huntington’s disease
March 21, 2018 - Quintupling inhaled steroid doses may not benefit children with asthma
March 21, 2018 - Study shows clear connection between cardiovascular fitness in middle age and dementia risk
March 21, 2018 - Premature babies have higher risks of health complications in Bangladesh
March 21, 2018 - Child’s temperament and parenting influence weight gain in babies
March 21, 2018 - Researchers find the heart to be capable of arrhythmia termination after local gene therapy
March 21, 2018 - Inhealthcare to provide digital infrastructure for NHS to help protect people from falls
March 21, 2018 - Flu Season Finally Slowing Down
AFib Tx at Rural Hospitals Tied to Higher Death Risk

AFib Tx at Rural Hospitals Tied to Higher Death Risk

image_pdfDownload PDFimage_print

Action Points

  • Patients hospitalized for atrial fibrillation in rural hospitals were more likely to die than patients admitted to urban hospitals.
  • The study suggests that improvement in atrial fibrillation care in rural hospitals is needed to further reduce the risk of mortality associated with hospital admission for atrial fibrillation.

Patients hospitalized for atrial fibrillation in rural hospitals were more likely to die than patients admitted to urban hospitals, according to a cross-sectional analysis involving close to 250,000 hospitalizations.

Rural hospital admission was associated with a 17% increased risk of death, compared with admission to urban hospitals in the adjusted multivariate model, reported Wesley T. O’Neal, MD, of Emory University School of Medicine in Atlanta, and colleagues.

Multivariate modelling adjusted for potential mortality confounders and propensity score-matched analysis both showed rural hospital mortality to be higher, as did subgroup analyses by sex, race, and region, they wrote in HeartRhythm.

The findings suggest that improvements in atrial fibrillation (AF) care could reduce mortality in rural hospital settings, they added, stating that “Further research is needed to understand the reasons for this finding and suggest that improvement in AF care in rural hospitals is needed to further reduce the risk of mortality associated with hospital admission for AF.”

Hospitalizations for atrial fibrillation have increased dramatically in the U.S. in recent years, with one study showing a 23% increase in a single decade (2000-2010).

The researchers noted that at least half a dozen studies published since 2000 suggest that quality of care, as well as outcomes, for patients hospitalized for cardiovascular causes varies between urban and rural hospitals. They added that mortality differences among patients admitted for atrial fibrillation have not been previously studied.

“Less optimal care of patients with AF has been reported in rural compared to urban areas, which supports the possibility of poorer outcomes in patients with AF admitted to rural hospitals,” they wrote.

In their cross-sectional examination of patients hospitalized for atrial fibrillation, the researchers analyzed data from the National Inpatient Sample for the period 2012 through 2014.

Hospitals were classified as urban or rural based on core-based statistical areas, while in-hospital mortality was defined as death due to any cause during hospitalization.

The mean age of the 248,785 patients included in the analysis was 69; 78% were white; and 48% were women. Also, 88% received treatment at urban hospitals and 12% were treated at rural hospitals.

Among the main findings, a higher percentage of patients admitted for atrial fibrillation died in rural hospitals compared to urban hospitals (1.3% versus 1.0%, P<0.001).

Patients admitted to rural hospitals had an increased risk for death compared with those admitted to urban hospitals in the multivariate model accounting for differences in patient characteristics (OR, 1.17, 95% CI 1.04 to 1.32).

The elevated death risk associated with urban hospital admission persisted after exclusion of patients who had external electrical cardioversion or catheter ablation procedures (OR, 1.14, 95% CI 1.01 to 1.28).

Similar results were seen in a propensity score-matched cohort and in subgroup analyses by sex, race, and region.

Patients admitted to urban hospitals for atrial fibrillation were more likely to have secondary diagnoses of heart failure, hyperlipidemia, and acute kidney injury than those from rural hospitals.

The researchers noted that the risk of in-hospital mortality in patients admitted for atrial fibrillation has actually declined in recent years, due, in part, to the greater use of treatments like external electrical cardioversion and catheter ablation.

They added that while the reasons for the observed rural hospital death increase are unclear, “differences in practice patterns possibly explain this finding.”

Eight percent of the patients in the cohort admitted to urban hospitals received external electrical cardioversion versus 4% of patients treated at rural hospitals (P<0.001), while 9% of patients treated at urban hospitals received catheter ablation, compared with just 1% of patients treated at rural hospitals.

In an accompanying editorial, Thomas Deering, MD, and Ashish Bhimani, MD, of the Piedmont Heart Institute in Atlanta, wrote that while some studies have shown inequities in atrial fibrillation care in rural hospitals, others have shown no significant differences in care compared with non-rural hospitals.

“If the higher rural AF mortality rates noted in the study by O’Neal et al were related primarily to the delivery of AF care, one might expect to see higher cardiovascular and/or stroke-related mortality rates and not just overall higher mortality rates,” they wrote. “Unfortunately, the methodologic design of this study precludes such an analysis. Furthermore, the small absolute mortality difference between rural (1.3%) and urban (1.0%) patients, in which the reasons for those differences remain unknown, makes it difficult to determine the clinical importance of the observed results and suggest effective health policy approaches.”

Study limitations included the inability to distinguish between cases of new-onset and preexisting atrial fibrillation and lack of information on cause of death.

The study was funded by the National Heart, Lung, and Blood Institute.

O’Neal and co-authors, as well as Deering and Bhimani, disclosed no relevant relationships with industry.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


last updated

Tagged with:

About author

Related Articles