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 Researchers examined data on 248,731 adults nationwide who were
hospitalized for atrial fibrillation between 2012 and 2014. After
accounting for patient characteristics and medical issues that can
influence survival odds, rural patients were 17 percent more likely
to die in the hospital, the study found.
“Presumably, a higher risk of death in patients from rural regions
was related to differences in practice patterns and access to
specialists,” said lead study author Dr. Wesley O’Neal of Emory
University School of Medicine in Atlanta, Georgia.
Atrial fibrillation is often managed with medication. For more
troublesome cases, common treatments include ablation, a minimally
invasive surgery to destroy heart tissue that’s causing abnormal
heart rhythms, and cardioversion, a procedure to shock the heart
into a normal rhythm.
Both of these procedures were more likely to be done at urban
hospitals, the study found.
“Although we cannot equate a specific number or percentage of the
observed mortality risk to differences in practice patterns or
access to specialty care, our data do suggest that these differences
exist,” O’Neal said by email.
In atrial fibrillation, electrical impulses in the upper chambers of
the heart are chaotic, causing part of the heart muscle to quiver
rather than contracting normally. As a result, blood doesn’t move as
well to the heart’s lower chambers. This can lead to the formation
of clots that can travel through the arteries. The risk of stroke is
up to seven times higher in people with atrial fibrillation than in
people without the disorder.
The analysis included almost 219,000 urban patients and nearly
30,000 urban patients from 44 states and the District of Columbia,
representing more than 96 percent of the U.S. population.
Rural atrial fibrillation patients were more likely to die of all
causes during their hospital stays, researchers report in Heart
Rhythm.
This held true after accounting for several common medical
conditions that can accompany atrial fibrillation including high
blood pressure, diabetes, heart failure and kidney damage.
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Overall, 8 percent of urban atrial fibrillation patients had
cardioversion procedures, compared with just 4 percent of their
urban counterparts, the study found.
At the same time, 9 percent of urban patients got ablation
procedures for atrial fibrillation, compared with 1 percent of
people in rural hospitals.
About 1.3 percent of atrial fibrillation patients died in rural
hospitals, compared with 1 percent in urban facilities.
The study wasn’t a controlled experiment designed to prove whether
or how hospital locations might influence survival odds for patients
admitted with atrial fibrillation.
Researchers also lacked data on the severity of medical conditions
that might impact survival odds, the authors note.
The severity of problems like diabetes and high blood pressure can
impact survival odds, as can access to care in the community,
lifestyle factors and how well physicians follow guidelines for
diagnosing and treating atrial fibrillation, Dr. Thomas Deering and
Dr. Ashish Bhimani of the arrhythmia center at the Piedmont Heart
Institute in Atlanta write in an accompanying editorial.
“Existing information suggests that rural patients may have higher
overall and cardiovascular mortality rates,” Deering said by email.
“There is also some limited data suggesting that several atrial
fibrillation outcomes, for example appropriate anticoagulation usage
and appropriate referral for advanced procedural options such as
ablation, are lower in rural than urban settings.”
SOURCE: http://bit.ly/2CbXQp1 Heart Rhythm, online December 10,
2017.
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