Rural-Urban Disparities in Mortality of Patients with Acute Myocardial Infarction and Heart Failure: A Systematic Review and Meta-Analysis.

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Babar Faridi, Steven Davies, Rashmi Narendrula, Allan Middleton, Rony Atoui, Sarah McIsaac, Sami Alnasser, Renato D Lopes, Mark Henderson, Jeff S Healey, Dennis T Ko, Mohammed Shurrab
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引用次数: 0

Abstract

Aims: Patients with cardiac disease living in rural areas may face significant challenges in accessing care and studies suggest that living in rural areas may be associated with worse outcomes. However, it is unclear whether rural-urban disparities have an impact on mortality in patients presenting with acute myocardial infarction (AMI) and heart failure (HF). This meta-analysis aimed to assess differences in mortality between rural and urban patients presenting with AMI and HF.

Methods: A systematic search of the literature was performed using PubMed, Embase, MEDLINE and CENTRAL for all studies published until January 16, 2024. A grey literature search was also performed using a manual web search. The following inclusion criteria were applied: (i) studies must compare rural patients to urban patients presenting to hospital with AMI or HF; and (ii) studies must report on mortality. The primary outcome was all-cause mortality. Comprehensive data were extracted including study design, patient characteristics (sex, age and comorbidities), sample size, follow-up period and outcomes. Odds ratios (ORs) were pooled with random-effects model. A subgroup analysis was performed to investigate causes for heterogeneity in which studies were separated based on in-hospital mortality, post-discharge mortality, and region of origin including North America, Europe, Asia and Australia.

Results: In total, 37 studies were included (29 retrospective studies, 4 cross-sectional studies and 4 prospective cohort studies) in our meta-analysis; 24 studies for AMI, 11 studies for HF and 2 studies for both AMI and HF. This included a total of 21,107,886 patients with AMI (2,230,264 of which were in rural regions) and 18,434,270 patients with HF (2,655,469 of which were in rural regions). Rural patients with AMI had similar age (mean age 69.8 +/- 5.7; vs 67.5 +/- 5.1) and were more likely to be female (43.2% vs 38.5%) compared to urban patients. Rural patients with HF had similar age (mean age 77.1 +/- 4.4 vs 76.5 +/- 4.2) and were more likely to be female (56.4% vs 49.5%) compared to urban patients. The range of follow-up for the AMI cohort was 0 days to 24 months and the range of follow-up for the HF cohort was 0 days to 24 months. Compared with urban patients, rural patients with AMI had higher mortality rate at follow-up (15.5% vs 13.4%; OR 1.18, 95% CI, 1.13-1.24; I2 = 97%). Compared with urban patients, rural patients with HF had higher mortality rate at follow-up (12.3% vs 11.6%; OR 1.11, 95% CI, 1.11-1.12; I2 = 98%).

Conclusions: To our knowledge, this is the first systematic review and meta-analysis assessing mortality differences between rural and urban patients presenting with AMI and HF. We found that patients living in rural areas had an increased risk of mortality when compared to patients in urban areas. Clinical and policy efforts are required to reduce these disparities.

急性心肌梗死和心力衰竭患者死亡率的城乡差异:系统回顾与元分析》。
目的:生活在农村地区的心脏病患者在获得医疗服务方面可能面临巨大挑战,而且研究表明,生活在农村地区可能与较差的预后有关。然而,目前尚不清楚城乡差异是否会影响急性心肌梗死(AMI)和心力衰竭(HF)患者的死亡率。这项荟萃分析旨在评估城乡急性心肌梗死和心力衰竭患者死亡率的差异:使用 PubMed、Embase、MEDLINE 和 CENTRAL 对 2024 年 1 月 16 日之前发表的所有研究进行了系统的文献检索。此外,还通过手动网络搜索进行了灰色文献检索。纳入标准如下:(i) 研究必须将农村患者与因急性心肌梗死或高血压而入院的城市患者进行比较;(ii) 研究必须报告死亡率。主要结果为全因死亡率。提取的综合数据包括研究设计、患者特征(性别、年龄和合并症)、样本大小、随访时间和结果。采用随机效应模型对比值比(ORs)进行了汇总。为了研究异质性的原因,还进行了亚组分析,根据院内死亡率、出院后死亡率以及来源地区(包括北美、欧洲、亚洲和澳大利亚)对研究进行了分类:我们的荟萃分析共纳入了 37 项研究(29 项回顾性研究、4 项横断面研究和 4 项前瞻性队列研究);其中 24 项研究针对急性心肌梗死,11 项研究针对高血压,2 项研究同时针对急性心肌梗死和高血压。其中包括 21,107,886 例急性心肌梗死患者(其中 2,230,264 例在农村地区)和 18,434,270 例心房颤动患者(其中 2,655,469 例在农村地区)。与城市患者相比,农村急性心肌梗死患者的年龄相仿(平均年龄为 69.8 +/- 5.7;vs 67.5 +/- 5.1),女性患者的比例更高(43.2% vs 38.5%)。农村心房颤动患者的年龄相近(平均年龄 77.1 +/- 4.4 vs 76.5 +/- 4.2),与城市患者相比,女性患者的比例更高(56.4% vs 49.5%)。急性心肌梗死队列的随访范围为 0 天至 24 个月,高血压队列的随访范围为 0 天至 24 个月。与城市患者相比,农村急性心肌梗死患者的随访死亡率更高(15.5% vs 13.4%;OR 1.18,95% CI,1.13-1.24;I2 = 97%)。与城市患者相比,农村心房颤动患者的随访死亡率更高(12.3% vs 11.6%;OR 1.11,95% CI,1.11-1.12;I2 = 98%):据我们所知,这是首次对患有急性心肌梗死和心房颤动的农村和城市患者的死亡率差异进行评估的系统回顾和荟萃分析。我们发现,与城市患者相比,农村患者的死亡风险更高。需要在临床和政策方面做出努力来减少这些差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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