Atrial fibrillation is more deadly in rural hospitals



By LISA RAPAPORT
Reuters


January 08. 2018 8:49 PM


Researchers examined data from 248,731 adults hospitalized for atrial fibrillation between 2012 and 2014 and found that rural patients had a 17 a hundred times more likely to die in the hospital. (Dreamstime)

Among American patients hospitalized for the common heart rhythm disorder known as atrial fibrillation, those living in rural areas may die more than their urban counterparts, a new study suggests.

Researchers examined the data in 248,731 adults across the country who were hospitalized for atrial fibrillation between 2012 and 2014. After taking into account the patient's characteristics and medical problems that may influence the chances of survival, patients Rural women were 17 percent more likely to die in the hospital, according to the study.

Presumably, an increased risk of death in patients from rural regions was related to differences in practice patterns and access to specialists, "said the study's lead author, Dr. Wesley O & Neal of the School of Medicine. Medicine from Emory University in Atlanta, Georgia.

Atrial fibrillation is often treated with medication.For more problematic cases, common treatments include ablation, a minimally invasive surgery to destroy the heart tissue that is causing abnormal heart rhythms and cardioversion, a procedure to electrocute the heart at a normal rate.

Both procedures were more likely to be done in urban hospitals, the study found.

"Although we can not equate a specific number or percentage of the mortality risk observed To differences in patterns of practice or access to specialized care, our data suggest that these differences There are, "O & # 39; Neal said by email.

In atrial fibrillation, the electrical impulses in the upper chambers of the heart are chaotic, causing part of the heart muscle to tremble instead of contracting normally. As a result, the blood does not move as well to the lower chambers of the heart. This can lead to the formation of clots that can travel through the arteries. The risk of stroke is up to seven times higher in people with atrial fibrillation than in people without the disorder.

The analysis included nearly 219,000 urban patients and nearly 30,000 urban patients from 44 states and the District of Columbia, representing more than 96 Percentage of the US population. UU

Rural atrial fibrillation patients were more likely to die from all causes during their hospital stay, researchers at Heart Rhythm reported.

This was maintained after taking into account several common medical conditions that may accompany atrial fibrillation including high blood pressure, diabetes, heart failure and kidney damage.

Overall, 8 percent of patients with urban atrial fibrillation had cardioversion procedures, compared to only 4 percent of their urban counterparts, the study found.

At the same time, 9 percent of urban patients obtained ablation procedures for atrial fibrillation, compared to 1 percent of people in rural hospitals.

Approximately 1.3% of patients with atrial fibrillation died in rural hospitals, compared to 1% in urban facilities.

The study was not a controlled experiment designed to demonstrate whether hospital locations could influence the chances of survival of patients admitted with atrial fibrillation.

The researchers also noted that the researchers lacked data on the severity of medical conditions that could affect the chances of survival.

The severity of problems such as diabetes and high blood pressure can affect the chances of survival, such as access to care in the community. Lifestyle factors and how well doctors follow the guidelines for diagnosing and treating atrial fibrillation, Dr. Thomas Deering and Dr. Ashish Bhimani of the arrhythmia center at the Piemont Heart Institute in Atlanta write in an accompanying editorial.

"Existing information suggests that patients may have higher cardiovascular and general mortality rates," Deering said by email.

"There is also a limit to data suggesting that various outcomes of atrial fibrillation, for example, the appropriate use of anticoagulation and the appropriate derivation for advanced procedural options such as ablation, are lower in rural than in urban settings."

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