In-hospital mortality among rural Medicare patients with acute myocardial infarction: the influence of demographics, transfer, and health factors

J Rural Health. Winter 2011;27(4):394-400. doi: 10.1111/j.1748-0361.2010.00351.x. Epub 2011 Jan 4.

Abstract

CONTEXT/PURPOSE: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients.

Methods: Cross-sectional retrospective analyses on 2003-2005 Medicare hospital inpatient data from 5 states were conducted to compare predictors of in-hospital AMI mortality between rural hospital transferred and nontransferred patients. A total of 9,690 rural hospital AMI patients were identified: 3,087 were transferred to receiving hospitals and 6,603 were not transferred. Separate logistic regressions were conducted for transferred and nontransferred patient cohorts and results were compared.

Results: Transfer patients were younger, more likely male, had fewer comorbidities/complications, and were less likely to expire (5.3% vs 16.7%) in the hospital. Congestive heart failure and cardiac dysrhythmia were the most common comorbidities/complications among transfer and no-transfer AMI patients, but shock (OR = 9.44) and acute renal failure (OR = 3.67) had the strongest associations with in-hospital mortality for both cohorts. Undergoing a percutaneous coronary intervention (PCI) was associated with a 42% reduction in hospital mortality risk for transfer patients.

Conclusions: Transfer was associated with a greater likelihood of in-hospital AMI survival, largely but not fully explained by transfer patients being younger with fewer comorbidities/complications who are receiving advanced cardiac care. Additional studies are needed to clarify other factors that explain higher in-hospital mortality among nontransfers, such as patients' health care decision-making.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Demography*
  • Female
  • Health Status
  • Hospital Mortality*
  • Hospitals, Rural / statistics & numerical data*
  • Hospitals, Special
  • Humans
  • Male
  • Medicare / statistics & numerical data*
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Patient Transfer / statistics & numerical data*
  • Retrospective Studies
  • Rural Population
  • United States / epidemiology