Scholars@Duke publication: 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).

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).

Publication , Journal Article

Ambardekar, AV; Fonarow, GC; Dai, D; Peterson, ED; Hernandez, AF; Cannon, CP; Krantz, MJ; Get With The Guidelines Steering Committee and Hospitals,

Published in: Am J Cardiol

January 15, 2010

Published version (DOI) Link to item

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 hospitals (5.7% vs 4.4%, p <0.0001), but this was not significant in multivariate analysis (odds ratio 1.05, 95% confidence interval 0.87 to 1.26). In conclusion, within the GWTG-CAD quality improvement initiative, patients with CAD treated at rural hospitals receive similar quality of care and have similar outcomes as those at urban centers.

Duke Scholars

Author Adrian Felipe Hernandez Medicine, Cardiology

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Published In

Am J Cardiol

DOI

10.1016/j.amjcard.2009.09.003

EISSN

1879-1913

Publication Date

January 15, 2010

Volume

105

Issue

Start / End Page

139 / 143

Location

United States

Related Subject Headings

United States
Quality of Health Care
Practice Guidelines as Topic
Myocardial Revascularization
Male
Length of Stay
Humans
Hospitals, Urban
Hospitals, Rural
Hospital Mortality

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APA

Chicago

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Ambardekar, A. V., Fonarow, G. C., Dai, D., Peterson, E. D., Hernandez, A. F., Cannon, C. P., … Get With The Guidelines Steering Committee and Hospitals, . (2010). 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). Am J Cardiol, 105(2), 139–143. https://doi.org/10.1016/j.amjcard.2009.09.003

Ambardekar, Amrut V., Gregg C. Fonarow, David Dai, Eric D. Peterson, Adrian F. Hernandez, Christopher P. Cannon, Mori J. Krantz, and Mori J. Get With The Guidelines Steering Committee and Hospitals. “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).” Am J Cardiol 105, no. 2 (January 15, 2010): 139–43. https://doi.org/10.1016/j.amjcard.2009.09.003.

Ambardekar AV, Fonarow GC, Dai D, Peterson ED, Hernandez AF, Cannon CP, et al. 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). Am J Cardiol. 2010 Jan 15;105(2):139–43.

Ambardekar, Amrut V., et al. “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).” Am J Cardiol, vol. 105, no. 2, Jan. 2010, pp. 139–43. Pubmed, doi:10.1016/j.amjcard.2009.09.003.

Ambardekar AV, Fonarow GC, Dai D, Peterson ED, Hernandez AF, Cannon CP, Krantz MJ, Get With The Guidelines Steering Committee and Hospitals. 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). Am J Cardiol. 2010 Jan 15;105(2):139–143.