Breaking News
August 18, 2018 - Immigrants Not a Burden on U.S. Health Care: Study
August 18, 2018 - Women who eat fast food take longer to become pregnant
August 18, 2018 - Most YouTube videos on plastic surgery are misleading marketing campaigns
August 18, 2018 - The essential guide to make your laboratory more sustainable
August 18, 2018 - Researchers describe promising strategy to remove melanoma’s most powerful defenses
August 18, 2018 - Women with polycystic ovary syndrome dissatisfied with medical care
August 18, 2018 - Research discoveries reveal insights behind neurological degeneration
August 18, 2018 - Researchers win multi-million Euro award to conduct research into liver disease
August 18, 2018 - Survey highlights variations in practice of airway management in pediatric intensive care units
August 18, 2018 - UK students win sponsorship from Promega Corporation
August 18, 2018 - Janssen Reports Positive Topline Results for ATLAS Phase III Study of a Novel, Long Acting Injectable Two-Drug Regimen for the treatment of HIV-1
August 18, 2018 - PSD as a molecular platform for understanding synapse formation and plasticity
August 18, 2018 - Improved visual communication could help patients to make informed health-care decisions
August 18, 2018 - New algorithm helps identify and manage diabetic patients at increased fracture risk
August 18, 2018 - Microscopic insect odour detecting mechanisms discovered
August 18, 2018 - Researchers develop new approach to study how tuberculosis infects people
August 18, 2018 - FDA Approves Kalydeco (ivacaftor) for Cystic Fibrosis in Children Ages 12 to
August 18, 2018 - An ion channel differentiates newborn and mature neurons in the adult brain
August 18, 2018 - Socio-economic position associated with pregnant women’s exposure to environmental hazards
August 18, 2018 - Voters to settle dispute over ambulance employee break times
August 18, 2018 - AGA urges policymakers and stakeholders to improve affordability of drugs
August 18, 2018 - Increasing dietary protein may lower risk of diabetes in people with NAFLD
August 18, 2018 - New HIV therapy suppresses viral replication and increases immune cells in drug-resistant patients
August 18, 2018 - Broad Genetic Testing for NSCLC May Not Improve Survival
August 18, 2018 - Discovery opens door for synthetic opioids with less addictive qualities
August 18, 2018 - Transgenic rice plant extracts could help stop the spread of HIV
August 18, 2018 - Hologic’s Cynosure division partners with Porter Instrument to distribute nitrous oxide and oxygen system
August 18, 2018 - Two thyroid medications recalled by FDA
August 18, 2018 - Forecast Sees Abnormal Heat Worldwide Through 2022
August 18, 2018 - Childhood absence epilepsy – Genetics Home Reference
August 18, 2018 - Fearing hard Brexit, UK drugmakers stockpile to protect lives
August 18, 2018 - Discovery may help broaden the scope of defenses against HPV
August 18, 2018 - When they start thinking green, they see green
August 18, 2018 - Scientists introduce microfluidics-based chip for manipulation and analysis of single cells
August 18, 2018 - Researchers design new way to grow nose cells for treating spinal cord injuries
August 18, 2018 - New light shed on relationship between calorie-burning fat and muscle function
August 18, 2018 - Surgery Saturday Instagram series takes you inside Stanford’s OR
August 18, 2018 - Researchers uncover surprising new role for inhibition in the cerebellum
August 18, 2018 - Children have better nutrition when they live near forests, global study shows
August 18, 2018 - OHSU professor conducts clinical trial with artificial pancreas using Xeris’ liquid glucagon
August 18, 2018 - HSS takes young patients with physical challenges on a surfing trip
August 18, 2018 - Study shows electronic health records leave doctors and patients unsatisfied
August 18, 2018 - Study uncovers mechanism that affects multiplication of dengue virus lineage
August 18, 2018 - UTHealth safety expert talks about preparing for the most destructive hurricanes
August 18, 2018 - Theravance Biopharma Reports Positive Top-Line Four-Week Data from Phase 2 Trial of TD-9855 for the Treatment of Symptomatic Neurogenic Orthostatic Hypotension
August 18, 2018 - Animations prove effective in accurately measuring pain
August 18, 2018 - Three faculty members appointed to endowed positions | News Center
August 18, 2018 - New technique detects, measures, analyzes unevenly charged biomolecules
August 18, 2018 - Brief exposures to stressors can be beneficial to cells, shows study
August 18, 2018 - UTHealth-led survey shows much work remains to increase safety of e-health records
August 18, 2018 - Researchers use super-resolution microscope to unravel secrets of deadly Nipah virus
August 18, 2018 - Scientists identify pathways that reveal insights into mechanism of lung cancer etiology
August 18, 2018 - Rush’s health care IT leaders reach White House
August 18, 2018 - FDA approves marketing of brainsway deep transcranial magnetic stimulation system for OCD
August 17, 2018 - OUHSC gets $20 million grant to advance research and patient care for Oklahomans
August 17, 2018 - Sperm morphology differs depending on qualities of male bird
August 17, 2018 - Texas A&M researchers develop clay-based platform to grow blood vessels
August 17, 2018 - FDA Approves Expanded Indication for Orkambi (lumacaftor/ivacaftor) in Children Ages 2-5 Years
August 17, 2018 - Caring for Concussions | NIH News in Health
August 17, 2018 - Team explores diabetes drug’s ability to treat RSV infection
August 17, 2018 - New imaging technique can spot tuberculosis infection in an hour | News Center
August 17, 2018 - PolyU researchers design new self-fitting scaffold to induce bone regeneration
August 17, 2018 - CartiHeal and LSU Health successfully enroll first two patients in Agili-C IDE pivotal study
August 17, 2018 - Less-invasive options are slowing disease progression in glaucoma patients
August 17, 2018 - Researchers discover new promising target point for cancer and diabetes therapies
August 17, 2018 - Podcast: KHN’s ‘What the Health?’ See you in court!
August 17, 2018 - New mobile phone application enables early detection of cerebral ictus
August 17, 2018 - AJMC addresses role of community pharmacies in boosting adult vaccination rates
August 17, 2018 - UK’s leading sight loss charity invites applications from brightest minds in ophthalmic research
August 17, 2018 - Alternative devices can help when autoinjectors are unavailable
August 17, 2018 - Researchers produce artificial placenta model that closely resembles natural organ
August 17, 2018 - Study offers possibility of squelching a focal epilepsy seizure before symptoms appear
August 17, 2018 - FDA Alert: Temporary Total Artificial Heart Companion 2 Driver System by SynCardia Systems: Letter to Health Care Providers
August 17, 2018 - New statewide program in North Dakota aims to stem opioid misuse
August 17, 2018 - Researchers discover why sepsis from a staph infection causes organ failure
August 17, 2018 - Stony Brook University’s new medical students start a transformative journey
August 17, 2018 - Revealed: The molecular mechanism underlying hypertrophic cardiomyopathy | News Center
August 17, 2018 - New modeling studies highlight urgent need for effective drug policy reforms to prevent HIV
August 17, 2018 - Research explores relationship between personal history of infectious fever and cancer risk
August 17, 2018 - Study finds rise in cases of progressive massive fibrosis among U.S. coal miners
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

2017-12-12T00:00:00-0500

last updated

Tagged with:

About author

Related Articles