Abstract 4071: Heart Failure Patients in Rural Areas have Better Event-Free Survival than Those Living in Urban Areas
Evidence of health disparities between urban and rural populations usually favors those in urban areas. Unknown is the impact of rurality on heart failure (HF) outcomes. The purpose of this study was to compare event-free survival between HF patients (pts) living in urban and rural areas. We enrolled 136 pts with HF (male 70%, age 61±11 yrs, NYHA III/IV 60%). Demographic, clinical and psychosocial data were collected by questionnaires and medical record review. Events (emergency department visits for HF, rehospitalization and death) were identified by patient/family interview and hospital data base review. Rural status was determined by linking pts ZIP code to its rural-urban commuting area code (RUCA). Kaplan-Meier plots determined event-free survival. Cox regression modeling determined the effect of rurality on outcomes controlling for demographic, clinical and psychosocial variables. 36% of pts were urban and 64% were rural. Event-free survival was better in rural than urban pts (Figure⇓). In Cox analysis, rurality (p = .048) and depression (p = .037) predicted event-free survival controlling for age, marital status, NYHA class, ACE inhibitor use, medication adherence, and perceived social support. Urban pts were 1.76 times more likely to experience an event than rural pts. Rural pts were less likely than their urban counterparts to have an event. These results are striking as the groups were similar on most characteristics and the demographic and disease -specific variables for which they did differ were included as covariates. Further research is needed to identify protective factors unique to rural areas.