Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans
Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans
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DOI：
10.1111/j.1748-0361.2010.00318.x
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发表时间：
2010-09-01
影响因子：
4.9
通讯作者：
Kaboli, Peter J.
中科院分区：
文献类型：
--
作者：
Abrams, Thad E.;Vaughan-Sarrazin, Mary;Kaboli, Peter J.
简介：每年，超过3,000名农村退伍军人被接纳为退伍军人健康管理局（VA）医院急性心肌梗死（AMI），但没有AMI的研究已利用VA农村definition.Methods：这项回顾性队列研究确定了15,870例AMI入院的所有VA医院。农村居住地由城乡通勤区（RUCA）代码或VA城市/农村/高度农村（URH）系统确定。死亡率和冠状动脉血运重建的终点进行了调整，使用行政实验室和临床variables.Results：URH代码确定184（1%）退伍军人高度农村，6,046（39%）为农村，9,378（60%）为城市; RUCA代码确定了1，350名（9%）来自偏远城镇的退伍军人，3，505名（22%）来自小城镇或大城镇，10，345名（65%）来自城市地区。调整后的死亡率分析表明，使用URH或RUCA系统的农村退伍军人的死亡率风险相似。使用URH分类进行血运重建的风险表明，农村（HR，0.96; 95% CI，0.94-1.00）和高度农村退伍军人（HR，1.13; 0.96-1.31）与城市退伍军人相比无差异。相反，农村（相对于城市）由RUCA系统指定的退伍军人有较低的血运重建率;这对来自小城镇或大城镇的退伍军人都是如此（HR，0.89; 0.83-0.95）以及来自偏远城镇的退伍军人（HR，0.86; 0.78-0.93）。接受AMI护理的农村退伍军人有类似的30-日死亡率，但农村退伍军人接受血运重建的调整后的危险取决于所使用的农村分类系统。这些发现表明，农村退伍军人的血运重建率可能较低。
Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition.Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables.Results: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93).Conclusion: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans.