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. 2023 Aug;10(2):e002326.
doi: 10.1136/openhrt-2023-002326.

Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry

Jose Carlos Nicolau  1 , Ruth Owen  2 , Remo H M Furtado  3   4 , Shaun G Goodman  5 , Christopher B Granger  6 , Mauricio G Cohen  7 , Dirk Westermann  8 , Satoshi Yasuda  9 , Tabassome Simon  10   11 , Katarina Hedman  12 , Phillip R Hunt  13 , David B Brieger  14 , Stuart J Pocock  2
Affiliations

Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry

Jose Carlos Nicolau et al. Open Heart. 2023 Aug.

Abstract

Background: Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited.

Methods: The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged ≥50 years 1-3 years post-AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all-cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months.

Results: There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all-cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke.

Conclusions: Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed.

Trial registration number: NCT01866904.

Keywords: coronary artery disease; myocardial infarction; quality of health care.

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Conflict of interest statement

Competing interests: JCN has received research grants from Amgen, AstraZeneca, Bayer, Esperion, CLS Behring, Dalcor, Daiichi-Sankyo, Janssen, Novartis, Novo Nordisk, Sanofi, Vifor; honoraria/consultation from Daiichi-Sankyo, Novartis, Sanofi; and a scholarship from the Brazilian National Council for Scientific and Technological Development (CNPq #303448/2021/0). RO has received research grant support from AstraZeneca. RHMF reports research grants and personal fees from AstraZeneca, Bayer, Biomm and Servier, and research grants from Pfizer, EMS, Aché, CytoDin, Brazilian Ministry of Health, University Health Network (received from his institution) and Lemann Foundation Research Fellowship. SG has received research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Merck, Novartis, Novo Nordisk A/C, Pendopharm/Pharmascience, Pfizer, Regeneron, Sanofi, Servier and Valeo Pharma, and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Center for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, PERFUSE Research Institute, and TIMI Study Group (Brigham Health). CBG has received consulting honoraria and/or research grant support from Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi-Sankyo, Eli Lilly, Gilead, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Medtronic, Pfizer, Salix Pharmaceuticals, Sanofi, Takeda and The Medicines Company. MGC has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Medtronic, Abiomed and Merit Medical. DW has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Berlin-Chemie, Biotronik and Novartis. SY has received speaker/consulting honoraria and/or research grant support from Takeda, Daiichi-Sankyo, AstraZeneca and Boehringer Ingelheim. TS has received speaker/consulting honoraria and/or research grant support from Astellas, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer and Sanofi. KH and PRH are employees of AstraZeneca. DBB has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Eli Lilly, Merck and Sanofi. SP has received research grant support from AstraZeneca.

Figures

Figure 1
Figure 1
Cumulative incidence of (A) the composite of CV death, AMI and stroke by place of residence; (B) the composite of CV death, AMI, stroke and major bleeding events by place of residence. AMI, acute myocardial infarction; CV, cardiovascular.
See this image and copyright information in PMC

References

    1. Bhuyan SS, Wang Y, Opoku S, et al. . Rural-urban differences in acute myocardial infarction mortality: evidence from Nebraska. J Cardiovasc Dis Res 2013;4:209–13. 10.1016/j.jcdr.2014.01.006 - DOI - PMC - PubMed
    1. Kulshreshtha A, Goyal A, Dabhadkar K, et al. . Urban-rural differences in coronary heart disease mortality in the United States: 1999-2009. Public Health Rep 2014;129:19–29. 10.1177/003335491412900105 - DOI - PMC - PubMed
    1. Vallabhajosyula S, Dunlay SM, Barsness GW, et al. . Hospital-level disparities in the outcomes of acute myocardial infarction with cardiogenic shock. Am J Cardiol 2019;124:491–8. 10.1016/j.amjcard.2019.05.038 - DOI - PubMed
    1. Li X, Murugiah K, Li J, et al. . Urban-rural comparisons in hospital admission, treatments, and outcomes for ST-segment-elevation myocardial infarction in China from 2001 to 2011: a retrospective analysis from the China PEACE study (Patient-Centered Evaluative Assessment of Cardiac Events). Circ Cardiovasc Qual Outcomes 2017;10:e003905. 10.1161/CIRCOUTCOMES.117.003905 - DOI - PMC - PubMed
    1. Chow CK, Teo KK, Rangarajan S, et al. . Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013;310:959–68. 10.1001/jama.2013.184182 - DOI - PubMed

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