Quality of Care and In-Hospital Outcomes in Patients With Coronary Heart Disease in Rural and Urban Hospitals (from Get With the Guidelines–Coronary Artery Disease Program)
Abstract
Previous studies have suggested that patients with coronary artery disease (CAD) in rural areas may have worse outcomes due to limited availability of specialists, fewer resources, and less institutional funding. Data were collected from hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program (GWTG-CAD) from January 2000 to December 2008. In-hospital outcomes and quality of care were stratified by care at rural versus urban hospitals. Multivariate logistic regression analysis was used to determine the association of rural locale with in-hospital mortality, length of stay, and compliance with the GWTG-CAD performance measurements including (1) early aspirin use, (2) smoking cessation counseling and discharge prescriptions of (3) aspirin, (4) angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers for left ventricular systolic dysfunction, (5) beta-blockers, and (6) lipid-lowering therapy and a composite of all 6 measurements. Data were collected from 22,096 patients at 71 rural centers and 329,938 patients at 477 urban centers. Unadjusted rates of compliance with performance measurements were lower in rural (range 82.4% to 90.5%) compared to urban (range 81.3% to 95.0%) hospitals including the composite (74.7% vs 80.6%, p <0.0001). In multivariate analysis, rural status was not independently associated with lower compliance with any of the performance measurements. Unadjusted mortality rates were higher in rural versus urban ho…
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Coronary patients treated at remote hospitals receive similar quality of care and have similar outcomes as those at urban centers.
“The Get with the Guidelines-Coronary Artery Disease Program (GWTG-CAD) quality improvement initiative in the USA, which copes with a similar problem, showed that coronary patients treated at RHs receive similar quality of care and have similar outcomes as those at urban centers7”
From How do retired paramedics fit into remote, rural emergency departments? (2013) · cites this paper as [7]
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Medication adherence: emerging use of technology
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“Provider performance in achieving evidence-based guideline targets has improved [84], and interventions that improve provider compliance improve clinical patient outcomes [85], including decreased hospital readmission rates and hospitalized days.”
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- Authors
- Ambardekar, A. V., Fonarow, G. C., Dai, D., Peterson, E. D., Hernandez, A. F., Cannon, C. P., & Krantz, M. J.
- Affiliations
- Denver Health Medical Center (US)
- University of California, Los Angeles (US)
- Duke Clinical Research Institute (US)
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 105
- Issue
- 2
- Pages
- 139-143
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1977966752
- Cited by
- 37
- References
- 0
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2016: 8 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 3
- FWCI
- 6.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Heart Failure Society of America
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- coronary artery disease, rural hospitals, urban hospitals, quality of care, in-hospital mortality, length of hospital stay, aspirin, smoking cessation counseling, beta-blockers, ACE inhibitors, angiotensin receptor blockers, lipid-lowering therapy, left ventricular systolic dysfunction
- MeSH terms
- Aged, Cardiovascular Agents, Coronary Disease, Female, Hospitals, Rural, Hospitals, Urban, Humans, Length of Stay, Male, Myocardial Revascularization, Quality of Health Care, United States, Cohort Studies, Hospital Mortality, Practice Guidelines as Topic, Guideline Adherence
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