Abstract 10038: Rural/Urban Differences in Hospital Characteristics, Patient Presentation, Process-of-Care Measures, and Outcomes of 25,748 Acute Coronary Syndrome Admissions in Kerala, India: Results From the Kerala ACS Registry
Introduction: There are limited contemporary data on the rural/urban differences in patient presentation, process-of-care measures, and outcomes of acute coronary syndrome (ACS) admissions in India. The Cardiological Society of India - Kerala Chapter developed a prospective ACS registry to address this gap.
Hypothesis: We hypothesized that rural hospitals would have lower rates of in-hospital and discharge medical therapy, lower rates of revascularization, and higher rates of in-hospital- and 30-day outcomes compared with urban hospitals.
Methods: We prospectively collected data on 25,748 consecutive ACS admissions from 2007-2009 in 125 hospitals in Kerala, India.
Results: The Table describes differences among ACS admissions to rural and non-rural hospitals. Rural hospitals accounted for 40% of all participating hospitals, but only 23% (n=5,992) of admissions. Rural hospitals were also less likely to be staffed by a cardiologist. The mean ages of ACS patients at rural and urban hospitals were similar (60 years), but rural hospitals were more likely to admit women than urban hospitals. STEMI diagnosis at presentation was more common in rural (41%) compared with urban hospitals (36%). In-hospital medication rates of aspirin, clopidogrel, heparin, and beta-blockers and in-hospital angiography and PCI were generally lower in rural hospitals, but fibrinolysis rates were higher in rural hospitals. CABG rates were similar between the two groups. In-hospital discharge prescription rates of aspirin, clopidogrel, beta-blockers, and statins were also lower in rural hospitals. In-hospital mortality and combined mortality, stroke, reinfarction, and heart failure rates were lower in rural hospitals; these differences persisted at 30-day follow-up.
Conclusions: In conclusion, these data demonstrate substantial rural/urban differences in patient presentation, process-of-care measures, and in-hospital and 30-day outcomes for ACS patients in Kerala.
- © 2011 by American Heart Association, Inc.