Relationship between the place of living and mortality in patients with advanced heart failure
Muñoz, Miguel-Angel (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública)
Garcia, Raquel (Universitat Autònoma de Barcelona. Departament de Medicina)
Navas, Elena (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Duran, Julio (Clínica Sant Antoni)
Del Val García, José Luis (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Verdú Rotellar, Jose María (Universitat Autònoma de Barcelona. Departament de Medicina)

Data:	2020
Resum:	Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease. Population-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least 1 year after reaching New York Heart Association IV functional class, between 2010 and 2014. Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality. Mean age was 81. 6 (SD 8. 9) years, and 62% were women. Patients in rural areas were older, particularly women aged > 74 years (p = 0. 036), and presented lower comorbidity. Mortality percentages were 59 and 51% among rural and urban patients, respectively (p = 0. 030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend < 0. 001). Multivariate analyses confirmed that men (HR 1. 60, 95% confidence interval (CI) 1. 34-1. 90), older patients (HR 1. 05, 95% CI 1. 04-1. 06), Charlson comorbidity index (HR 1. 16, 95% CI 1. 11-1. 22), and residing in rural areas (HR 1. 35, 95% CI 1. 09 to 1. 67) was associated with higher mortality risk. Living in rural areas determines an increased risk of mortality in patients at final stages of heart failure.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Advanced heart failure ; Rural health ; Community healthcare ; Health inequalities
Publicat a:	BMC family practice, Vol. 21 (july 2020) , ISSN 1471-2296

DOI: 10.1186/s12875-020-01213-x
PMID: 32664876

10 p, 703.2 KB

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