Rurality and event-free survival in patients with heart failure

Heart Lung. 2010 Nov-Dec;39(6):512-20. doi: 10.1016/j.hrtlng.2009.11.002.


Background: Evidence of health disparities between urban and rural populations usually favors urban dwellers. The impact of rurality on heart failure (HF) outcomes is unknown.

Objective: We compared event-free survival between HF patients living in urban and rural areas.

Methods: In this longitudinal study, 136 patients with HF (male, 70%; age, mean ± SD 61 ± 11 years; New York Heart Association class III/IV, 60%) were enrolled. Patients' emergency department visits for HF exacerbation and rehospitalization during follow-up were identified. Rural status was determined by rural-urban commuting area code. Survival analysis was used to determine the effect of rurality on outcomes while controlling for relevant demographic, clinical, and psychosocial variables.

Results: Rural patients (64%) had longer event-free survival than urban patients (P = .015). Rurality (P = .04) predicted event-free survival after controlling for age, marital status, New York Heart Association class, medications, adherence to medications, depressive symptoms, and social support.

Conclusions: Rural patients were less likely than their urban counterparts to experience an event. Further research is needed to identify protective factors that may be unique to rural settings.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Female
  • Geography
  • Health Status Disparities
  • Heart Failure / epidemiology
  • Heart Failure / mortality*
  • Heart Failure / psychology
  • Humans
  • Kaplan-Meier Estimate
  • Longitudinal Studies
  • Male
  • Medication Adherence
  • Middle Aged
  • Multivariate Analysis
  • Pennsylvania / epidemiology
  • Proportional Hazards Models
  • Psychometrics
  • Rural Population / statistics & numerical data*
  • Social Support
  • Statistics as Topic
  • Surveys and Questionnaires
  • Treatment Outcome
  • United States / epidemiology